Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK Centre for Immunology and Infection, Hull-York Medical School, University of York, York, UK.
Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Sex Transm Infect. 2014 Sep;90(6):445-51. doi: 10.1136/sextrans-2014-051646. Epub 2014 Jun 30.
Pelvic inflammatory disease (PID) generates diagnostic difficulty even for experienced doctors. Junior doctors and nurses also assess women with symptoms suggestive of PID. We aimed to determine if and how PID diagnoses vary between clinicians with different experience levels.
Cross-sectional study conducted in U.K. sexual health clinic, nested within a Chlamydia trachomatis (CT), and Neisseria gonorrhoea diagnostic test accuracy study. Proportions and characteristics of women diagnosed clinically with PID by clinicians with varying experience were compared. Outcomes included demographics, presenting symptoms and signs and CT, and CT and/or gonococcal (GC) (CT/GC) positivity.
In 3804 women assessed by 36 clinicians, rates of PID, CT and GC were 4.4%, 10.5%, and 2.5%, with no differences between experienced and inexperienced clinicians (p=0.84, p=0.13 and p=0.07, respectively). 63.7% of PID diagnosed by experienced clinicians met Centers for Disease Control and Prevention (CDC) key clinical criteria versus 41.2% by inexperienced; experienced versus inexperienced OR 2.51; 95% CI 1.16 to 5.40). Proportions of CT (CT/GC)-positive PID increased with experience (5.9% (11.8%) to 31.9% (34.1%)); experienced versus inexperienced (OR 3.90; 95% CI 1.12 to 13.5). Percentages of women with CT (CT/GC) who were diagnosed with PID also rose with experience (2.2% (3.9%) to 14.2% (13.7%)), but CT prevalence in PID cases diagnosed by inexperienced clinicians (8.8%) was no greater than in all women they assessed (9.0%), suggesting poorer discriminative skills.
Clinical diagnostic acumen for PID improves with experience. Inexperienced clinicians should focus on the presence of lower abdominal pain with pelvic tenderness and consider additional supportive symptoms, to improve specificity of their diagnoses.
ISRCTN 42867448.
盆腔炎（PID）的诊断即使对于有经验的医生来说也具有一定难度。初级医生和护士也会对有 PID 症状的女性进行评估。我们旨在确定经验水平不同的临床医生在 PID 诊断方面是否存在差异，以及存在哪些差异。
这是在英国性健康诊所进行的一项横断面研究，嵌套在一项沙眼衣原体（CT）和淋病奈瑟菌诊断测试准确性研究中。比较了经验水平不同的临床医生临床诊断 PID 的女性的比例和特征。结果包括人口统计学特征、主要症状和体征以及 CT 和/或淋球菌（GC）（CT/GC）阳性。
在 36 名临床医生评估的 3804 名女性中，PID、CT 和 GC 的发生率分别为 4.4%、10.5%和 2.5%，经验丰富的临床医生与经验不足的临床医生之间无差异（分别为 p=0.84、p=0.13 和 p=0.07）。经验丰富的临床医生诊断为 PID 的患者中，符合疾病控制与预防中心（CDC）关键临床标准的比例为 63.7%，而经验不足的临床医生为 41.2%；经验丰富的临床医生与经验不足的临床医生的比值为 2.51；95%置信区间为 1.16 至 5.40）。CT（CT/GC）阳性 PID 的比例随经验的增加而增加（5.9%（11.8%）至 31.9%（34.1%））；经验丰富的临床医生与经验不足的临床医生的比值为 3.90；95%置信区间为 1.12 至 13.5）。随着经验的增加，CT（CT/GC）阳性诊断为 PID 的女性比例也有所上升（2.2%（3.9%）至 14.2%（13.7%）），但经验不足的临床医生诊断为 PID 的 CT 阳性患者的比例（8.8%）并不高于他们评估的所有女性（9.0%），这表明他们的诊断能力较差。
PID 的临床诊断能力随着经验的增加而提高。经验不足的临床医生应关注下腹痛伴盆腔压痛，并考虑其他支持性症状，以提高其诊断的特异性。
ISRCTN42867448。
