Pelvic Inflammatory Disease

The authors designed this study to describe the practices of emergency department pediatricians in the US related to the diagnosis and management of pelvic inflammatory disease (PID) in adolescent girls and to compare this experience with Centers for Disease Control and Prevention (CDCP) management guidelines.

The subjects were 104 pediatricians randomly selected from 659 members of the Section on Emergency Medicine of the American Academy of Pediatrics. The response rate was 56% on this telephone survey. A 42-item structured interview questionnaire assessed physician demographics, practice characteristics, PID diagnosis and management, and attitudes about sexually transmitted diseases in adolescents.

The results showed that 51 (94%) of 54 emergency department pediatricians had diagnosed PID in adolescents at least once in the past two years, and 35 (69%) had diagnosed PID, on average, once per month or more. Less than half the pediatricians routinely recommended hospital admission for adolescents with PID as suggested by the CDCP, and among those treating adolescents with PID as outpatients, just over half arranged close follow-up within 72 hours of initiating antibiotic treatment.

Although most emergency department pediatricians routinely suggested condom use and HIV testing after diagnosing a sexually transmitted disease, a minority routinely provided contraceptive counseling or written partner notification. Approximately two thirds of pediatricians surveyed indicated they thought the care of an adolescent with a sexually transmitted disease should be different from that of an adult and that this age group was more prone to medical complications.

The results of this survey suggest that emergency department pediatricians frequently diagnose PID in adolescent girls and understand the high risk of medical complications in this age group, but their management is often less aggressive than that recommended by the CDCP guidelines.

(Benaim J, et al. Adolescent girls and pelvic inflammatory disease. Arch Pediatr Adolesc Med 1998; 152:449-454)

COMMENT: School nurses can encourage early follow-up of PID if not scheduled at the time of initial visit.