Enhanced Pelvic Inflammatory Disease Surveillance in Two Erie County, New York Emergency Departments

Background: In New York State, gonococcal and chlamydial associated pelvic inflammatory disease (PID) is under-reported to health departments because diagnosis is not lab-based and report forms do not capture PID diagnoses.

Objectives: To pilot an enhanced PID surveillance tool for chlamydia and gonorrhea cases seen in emergency departments (EDs). We hypothesized that PID case definition based on treatment would capture ED cases.

Methods: Medical charts were reviewed for all female gonorrhea and chlamydia cases reported to the health department between January - July, 2009 from two Erie County EDs. The surveillance tool classified a case as PID if at least one of the following criteria was documented: (1) physical exam findings consistent with PID; (2) provider diagnosis of PID; or (3) treatment consistent with PID.

Results: Among chlamydia and gonorrhea ED cases reviewed, exam findings were consistent with PID in 14.6% (7/48) at ED-1 and 15.7% (8/51) at ED-2. However, PID diagnosis only appeared in the medical record in 8.3% (4/48) at ED-1 and 11.8% (6/51) at ED -2; therefore, 43% (3/7) of PID was missed at ED-1 and 25% (2/8) at ED-2. Among cases with PID exam findings, treatment followed CDC guidelines for 28.6% (2/7) at ED-1 and 50% (4/8) at ED-2. At ED-1, “abdominal pain” was the only medical record diagnosis for 6/48 (12.5%) chlamydia or gonorrhea cases. Lortab was prescribed for 6/48 ED-1 chlamydia or gonorrhea cases that presented with abdominal pain.

Conclusions: The enhanced PID surveillance tool was effective in large, busy EDs, revealing that many cases with exam findings consistent with PID were missed and inadequately treated. Monitoring treatment alone will miss most PID cases for surveillance.

Implications for Programs, Policy, and/or Research: ED provider training to diagnose and treat PID is needed. Surveillance for treatment alone will not capture most PID cases in EDs.