Appendix 1. List of Investigators in the URGO Group Who Did Not Meet Criteria for Authorship

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Fauconnier A, Provot J, LeCreff I, Boulkedid R, Vendittelli F, Doret-Dion M, et al. A framework proposal for quality and safety measurement in gynecologic emergency care. Obstet Gynecol 2020;136.

The authors provided this information as a supplement to their article.

Appendix 1. List of Investigators in the URGO Group Who Did Not Meet Criteria for Authorship

Souhail Alouini (CHR Orléans, Orléans, France), Aurélie Brossard (CHU de Poitiers, Poitiers, France), Perrine Capmas ((Hôpital du Kremlin-Bicêtre Bicêtre; APHP, Paris France), Caroline Digusto (CHU Bretonneau, Tours, France), Olivier Garbin (CMCO, Hôpitaux Universitaires de Strasbourg Schiltigheim, France), Nathalie Laurenceau (Hospices Civils de Lyon, Lyon, France), Guillaume Legendre (CHU Angers, Angers, France), Yaël Levy-Zauberman (Hôpital du Kremlin-Bicêtre Bicêtre;

APHP, Paris France), Lucie Merlet (CHU de Poitiers, Poitiers, France), Thuy Nguyen (Hôpital Louis Mourrier, Colombes; APHP, Paris, France), Pierre Panel (Centre Hospitalier de Versailles, Le Chesnay, France), Marie Timmermans (CHR de Liège; Université de Liège, Belgium)

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Appendix 2. Potentially Life-Threatening Gynecologic Emergencies and Near-Miss Case Criteria: Definitions From a 2-Round Delphi Consultation Potentially life-threatening gynecologic

emergencies

Near-miss case criteria

Ectopic pregnancy 1. with tubal rupture, or 2.

with active bleeding, or 3. with massive hemoperitoneum (estimated blood loss> 500 ml)

4. Hemorrhagic miscarriage (estimated blood loss> 500 ml)

Pelvic inflammatory disease complicated by 5.

tubo-ovarian abscess or 6. septic shock

7. Adnexal torsion (tube and/or ovary)

8. Appendicitis complicated by peritonitis or abscess

9. Bowel obstruction

Clinical Laboratory Care Management

1. Loss of consciousness regardless of stage and duration

2. Respiratory dysfunction (acute hypoxemia <60 mm Hg or SaO2

<90 in ambient air, mechanical or

non-invasive ventilation) excluding chronic respiratory disease and general anesthesia

3. Cardiac arrest (loss of consciousness and absence of heartbeat)

4. Hemodynamic instability (BP

<90 mm Hg twice or pulse>120 bts/minute twice) off induction

6. Acute thrombocytopenia (50,000 platelets per mm³)

7. Acute anemia (<7 g/dl) or drop in hemoglobin (>4 g/dl)

8. Transfusion of fresh frozen plasma

9. Transfusion of red blood cell units

10. Intensive Care Unit admission

11. Prolonged use of catecholamine> 90 minutes

12. Intubation and ventilation> 60 minutes (excluding general anesthesia)

13. Acute renal failure requiring dialysis

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10. Acute pyelonephritis with ureteral obstruction

11. Acute pyelonephritis during pregnancy

5. Hypothermia <35 degrees or hyperthermia> 40 degrees

14. Conversion to laparotomy for massive hemoperitoneum or intraoperative instability

15. Hysterectomy because of infection or hemorrhage

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Appendix 3. Prevalence of women with potentially life-threatening gynecologic emergencies (A) and rate of those hospitalized, among women consulting for acute pelvic pain (B), by center.

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Appendix 4. Activity, Patients Consulting for Acute Pelvic Pain, Patients Hospitalized, Potentially Life-Threatening Gynecologic Emergencies and Near-Misses, by Center

Centers GED

visits during

study period

Patients with first GED visit for APP n

Patients hospitalized

for APP, n

Rate of hospitalizations

among GED visits for APP,

% (95%CI)

G-PLE

cases, n Rate of G- PLE cases among ED

visits for APP, % (95%CI)

Rate of G- PLEs among hospitalized patients, %

(95%CI)

Near- misses,

n

Rate of near- misses among GED

visits for APP, % (95%CI)

Rate of near-misses

among hospitalized

patients, % (95%CI)

#1 1417 107 9 8.4 (3.8-14.5) 2 1.9 (0.0-

5.6) 22.2 (0.7-

56.0) 0 0.0 (0.0-1.6) 0.0 (0.0- 18.4)

#2 860 133 18 13.5 (8.2-19.9) 5 3.8 (1.1-

7.8) 27.8 (9.1-

51.1) 1 0.8 (0.0-3.2) 5.6 (0.0- 22.4)

#3 1271 527 46 8.7 (6.5-11.3) 18 3.4 (2.0-

5.2) 39.1 (25.4-

53.7) 3 0.6 (0.1-1.4) 6.5 (0.9- 15.9)

#4 1261 222 18 8.1 (4.8-12.1) 7 3.2 (1.2-

5.9) 38.9 (17.4-

62.7) 1 0.5 (0.0-1.9) 5.6 (0.0- 22.4)

#5 1106 54 10 18.5 (9.1-30.1) 0 0.0 (0.0-

3.2) 0.0 (0.0-

16.6) 0 0.0 (0.0-3.2) 0.0 (0.0- 16.6)

#6 574 109 10 9.2 (4.4-15.4) 3 2.8 (0.3-

6.9) 30.0 (5.1-

62.5) 1 0.9 (0.0-3.9) 10.0 (0.0- 38.1)

#7 620 98 7 7.1 (2.7-13.2) 1 1.0 (0.0-

4.3) 14.3 (0.0-

51.7) 0 0.0 (0.0-1.7) 0.0 (0.0- 23.4)

#8 185 148 8 5.4 (2.3-9.7) 4 2.7 (0.6-

6.1) 50.0 (15.5-

84.5) 1 0.7 (0.0-2.9) 12.5 (0.0- 46.2)

#9 1201 402 23 5.7 (3.6-8.2) 11 2.7 (1.3-

4.6) 47.8 (27.5-

68.5) 2 0.5 (0.0-1.5) 8.7 (0.2- 24.5)

#10 1101 188 8 4.3 (1.8-7.7) 4 2.1 (0.5-

4.8) 50.0 (15.5-

84.5) 2 1.1 (0.0-3.2) 25.0 (0.9- 61.5)

#11 672 230 25 10.9 (7.1-15.2) 13 5.7 (3.0-

9.1) 52.0 (32.2-

71.5) 1 0.4 (0.0-1.9) 4.0 (0.0- 16.4)

#12 1219 124 14 11.3 (6.2-17.5) 7 5.6 (2.2-

10.5) 50.0 (23.8-

76.2) 2 1.6 (0.0-4.8) 14.3 (0.4- 38.4)

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#13 760 226 23 10.2 (6.5-14.5) 7 3.1 (1.2-

5.8) 30.4 (13.1-

51.0) 3 1.3 (0.2-3.3) 13.0 (1.8- 30.5)

#14 492 74 7 9.5 (3.7-17.3) 3 4.1 (0.5-

10.0) 42.9 (8.4-

81.2) 0 0.0 (0.0-2.3) 0.0 (0.0- 23.4)

#15 327 126 13 10.3 (5.5-16.3) 3 2.4 (0.3-

5.9) 23.1 (3.6-

50.4) 0 0.0 (0.0-1.4) 0.0 (0.0- 12.9)

#16 1080 255 28 11.0 (7.4-15.1) 8 3.1 (1.3-

5.7) 28.6 (13.1-

46.9) 2 0.8 (0.0-2.3) 7.1 (0.1- 20.4)

#17 753 242 17 7.0 (4.1-10.6) 7 2.9 (1.1-

5.4) 41.2 (18.7-

65.6) 0 0.0 (0.0-0.7) 0.0 (0.0-9.9)

#18 914 153 16 10.5 (6.1-15.9) 8 5.2 (2.2-

9.4) 50.0 (25.4-

74.6) 4 2.6 (0.6-5.9) 25.0 (6.4- 49.5)

#19 319 85 19 22.4 (14.1-31.9) 6 7.1 (2.4-

13.6) 31.6 (12.3-

54.5) 4 4.7 (1.0-10.4) 21.1 (5.2- 42.7)

#20 696 131 17 13.0 (7.7-19.3) 3 2.3 (0.3-

5.7) 17.6 (2.6-

40.0) 0 0.0 (0.0-1.3) 0.0 (0.0-9.9)

#21 608 191 19 9.9 (6.1-14.6) 10 5.2 (2.5-

8.9) 52.6 (29.9-

74.9) 5 2.6 (0.7-5.5) 26.3 (8.6- 48.8)

Total 17436 3825 355 9.3 (7.8-10.8)^a 130 3.5 (3.0-

4.1)^b 36.6 (30.7-

42.7)^c 32 0.9 (0.5-1.3)^d 9.3 (6.1- 13.0)^e GED, Gynecologic emergency department

APP, Acute pelvic pain

a I-squared: 54,2 (25,0 to 72,1), Cochran's Q: 43,7, Chi2, p = 0.002 b I-squared 0 (0.0 to 43.6), Cochran's Q: 18.8, Chi2, p = 0.54 c I-squared: 26,8 (0,0 to 57,0), Cochran's Q: 27.3, Chi2, p = 0.13 d I-squared: 24,8 (0,0 to 55,9), Cochran's Q: 26.6, Chi2, p = 0.15 e I-squared: 20,2 (0,0 to 53,0), Cochran's Q: 25.1, Chi2, p = 0.20

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Appendix 5. Intrahospital time (A) and intradepartment time (B) to diagnose potentially life-threatening gynecologic emergencies (time between arrival at emergency department triage and receiving appropriate treatment). *Center 5 did not report any cases of potentially life-threatening gynecologic

emergencies.