National Trends in Pelvic Inflammatory Disease Among Adolescents in the Emergency Department

Abstract

Objective In 2002 the CDC broadened the pelvic inflammatory disease (PID) diagnostic criteria to increase detection and prevent serious sequelae of untreated PID. The impact of this change on PID detection is unknown. Our objective was to estimate trends in PID diagnosis among adolescent emergency department (ED) patients before and after the revised CDC definition and identify factors associated with PID diagnoses. Methods We performed a retrospective repeated cross-sectional study using the National Hospital Ambulatory Medical Care Survey from 2000–2009 of ED visits by 14 to 21 year old females. National estimates of PID rates were calculated. Multivariable logistic regression analyses and tests of trends were performed. Results During 2000–2009, of the 77 million female adolescent ED visits, there were an estimated 704,882 (95% CI 571,807, 837,957) cases of PID. Following the revised criteria, PID diagnosis declined from 5.4 cases per 1000 U.S. adolescent females to 3.9 cases per 1000 (p=0.03). In a multivariable model, age ≥17 years (OR 2.14, 95% CI 1.25, 3.64) and Black race (OR 2.04, 95% CI 1.36, 3.07) were associated with PID diagnosis Conclusions Despite broadened CDC diagnostic criteria, PID diagnoses did not increase over time. This raises concern about awareness and incorporation of the new guidelines into clinical practice.

Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009–2014: ecological analysis of hospital data

“…This is the first Australian study to assess PID rates using routinely collected ED data. Our findings of increasing PID rates contrast with a study in the USA that found falling PID rates (2002–2009) among adolescents attending EDs 14. For EP, stable or declining admission rates using live birth denominators have been reported in Australia and internationally until the 2000s, with increases in some groups 7 8 21.…”

Acute pelvic inflammatory disease in a sub-Saharan country: a cross sectional descriptive study

“…Some studies found that Black women were more affected by acute PID. 16,18 The majority of patients in our series had secondary school education (54.3%). This can be explained by the fact that students were more represented.…”

Adolescent and pediatric gynecology – quality of life and health

“…350-356) published in this issue of Current Opinion in Obstetrics and Gynecology, she provides an 'alternative look' at the published data on adolescents with PID, and concludes that there is limited evidence to guide the best practice strategies for young and middle adolescents with PID. The evidence supports the fact that adolescents and adult women receive suboptimal treatment for PID; large database reviews demonstrate that only 30-40% of patients received care according to the U.S. Centers for Disease Control (CDC) treatment guidelines [5,6]. Because adolescents are at increased risk for poor adherence to treatment regimens, and at increased risk of sexually transmitted disease (STD) reacquisition, they risk adverse reproductive health outcomes including infertility, recurrent PID, and chronic pelvic pain.…”