Mollen Cynthia J, Pletcher Jonathan R, Bellah Richard D, Lavelle Jane M
Division of Emergency Medicine, The Children's Hospital of Philadelphia, PA 19104, USA.
Pediatr Emerg Care. 2006 Sep;22(9):621-5. doi: 10.1097/01.pec.0000227868.23568.9d.
The rate of tubo-ovarian abscess (TOA) in adolescents with pelvic inflammatory disease (PID) is reported to range from 17% to 20%. However, no reports have focused specifically on the adolescent patient presenting to the emergency department (ED), regardless of whether they are treated in the inpatient or outpatient setting. Recent changes in the 2002 Centers for Disease Control and Prevention (CDC) Guidelines for the Treatment of Sexually Transmitted Diseases and sexually transmitted infection screening programs are likely to have impacted both the prevalence of PID and the rates of its complications, particularly TOA. Given that most patients with PID are treated as outpatients, it is imperative to accurately assess the prevalence of TOA in this population. Therefore, we sought to determine the rate of TOA in female adolescents diagnosed with PID in a large urban pediatric ED.
We performed a retrospective medical record review to assess the prevalence of TOA in adolescents diagnosed with PID in the ED by an attending physician in pediatric emergency medicine. All cases were identified on the basis of the clinical criteria from the 2002 CDC Guidelines for the Treatment of Sexually Transmitted Diseases. Data collected included historical and physical examination findings, and laboratory and radiological imaging results.
Three (2.4%; 95% confidence interval, 0.5-6.7) of 127 patients diagnosed with PID in the ED who had imaging or clinical follow-up were also found to have a TOA. The mean age of the patients was 16 years. Most patients (89%) had imaging studies performed within 24 hours; most of these studies (97%) were pelvic ultrasounds. Eleven patients did not have imaging but had clinical follow-up within 72 hours. Four patients were diagnosed with PID during the study period and were lost to follow-up.
The rate of TOA in adolescents diagnosed with PID in an urban pediatric ED is much lower than the rates previously reported in adolescents. This lower prevalence may be attributed to the broader 2002 CDC guidelines for diagnosing PID. In addition, community-based screening programs for Chlamydia trachomatis and Neisseria gonorrhoeae may help to identify young women at risk for developing PID earlier in the course of infection.
据报道，盆腔炎（PID）青少年患者中输卵管卵巢脓肿（TOA）的发生率在17%至20%之间。然而，尚无专门针对前往急诊科（ED）就诊的青少年患者的报告，无论他们是在住院还是门诊环境中接受治疗。2002年美国疾病控制与预防中心（CDC）性传播疾病治疗指南及性传播感染筛查计划的近期变化可能对PID的患病率及其并发症发生率，尤其是TOA产生了影响。鉴于大多数PID患者作为门诊患者接受治疗，准确评估该人群中TOA的患病率至关重要。因此，我们试图确定在一家大型城市儿科急诊科被诊断为PID的女性青少年中TOA的发生率。
我们进行了一项回顾性病历审查，以评估儿科急诊医学主治医师在急诊科诊断为PID的青少年中TOA的患病率。所有病例均根据2002年CDC性传播疾病治疗指南中的临床标准确定。收集的数据包括病史和体格检查结果，以及实验室和影像学检查结果。
在急诊科诊断为PID且有影像学或临床随访的127例患者中，有3例（2.4%；95%置信区间，0.5 - 6.7）也被发现患有TOA。患者的平均年龄为16岁。大多数患者（89%）在24小时内进行了影像学检查；其中大多数检查（97%）为盆腔超声检查。11例患者未进行影像学检查，但在72小时内进行了临床随访。4例患者在研究期间被诊断为PID，但失访。
在城市儿科急诊科被诊断为PID的青少年中，TOA的发生率远低于先前报道的青少年发生率。这种较低的患病率可能归因于2002年CDC更广泛的PID诊断指南。此外，基于社区的沙眼衣原体和淋病奈瑟菌筛查计划可能有助于在感染过程早期识别有患PID风险的年轻女性。
