In the Journals

Despite guidelines, PID treatment variable among ED clinicians

Most clinicians in the ED were not treating adolescent girls who presented with pelvic inflammatory disease in accordance with CDC guidelines, according to findings in a report published online.

Monika Goyal, MD, of Children’s National Medical Center, George Washington University, and colleagues analyzed 2000-2009 data from the National Hospital Ambulatory Medical Care Survey.

The researchers reported that only 37.1% of girls with pelvic inflammatory disease (PID) were treated according to the CDC treatment guidelines. “This finding has substantial implications because inadequate treatment of PID may lead to serious long-term sequelae such as chronic pelvic pain or tubal infertility,” Goyal and colleagues said.

The researchers reported an uptake in compliance after the guidelines were implemented in 2006, but many clinicians continued to inappropriately treat patients with ceftriaxone sodium and azithromycin, which may indicate that the clinicians believe treatment of PID is identical to treatment of cervicitis or that they are worried patients will not adhere to doxycycline regimens.

“We were surprised that almost two-thirds of adolescent patients diagnosed with PID in EDs were being treated inappropriately,” Goyal told Infectious Diseases in Children. “This supports the need for the creation of quality improvement interventions to improve the care of this vulnerable population.”

The researchers said their findings highlight the potential high impact of using the ED as a strategic setting to further understand these issues and change clinical practice.

Monika Goyal, MD, can be reached at Children’s National Medical Center, Division of Emergency Medicine, 111 Michigan Ave. NW, Washington, D.C. 20010; email mgoyal@cnmc.org.

Disclosure: Goyal reports no relevant financial disclosures.

Most clinicians in the ED were not treating adolescent girls who presented with pelvic inflammatory disease in accordance with CDC guidelines, according to findings in a report published online.

Monika Goyal, MD, of Children’s National Medical Center, George Washington University, and colleagues analyzed 2000-2009 data from the National Hospital Ambulatory Medical Care Survey.

The researchers reported that only 37.1% of girls with pelvic inflammatory disease (PID) were treated according to the CDC treatment guidelines. “This finding has substantial implications because inadequate treatment of PID may lead to serious long-term sequelae such as chronic pelvic pain or tubal infertility,” Goyal and colleagues said.

The researchers reported an uptake in compliance after the guidelines were implemented in 2006, but many clinicians continued to inappropriately treat patients with ceftriaxone sodium and azithromycin, which may indicate that the clinicians believe treatment of PID is identical to treatment of cervicitis or that they are worried patients will not adhere to doxycycline regimens.

“We were surprised that almost two-thirds of adolescent patients diagnosed with PID in EDs were being treated inappropriately,” Goyal told Infectious Diseases in Children. “This supports the need for the creation of quality improvement interventions to improve the care of this vulnerable population.”

The researchers said their findings highlight the potential high impact of using the ED as a strategic setting to further understand these issues and change clinical practice.

Monika Goyal, MD, can be reached at Children’s National Medical Center, Division of Emergency Medicine, 111 Michigan Ave. NW, Washington, D.C. 20010; email mgoyal@cnmc.org.

Disclosure: Goyal reports no relevant financial disclosures.