Enhanced Pelvic Inflammatory Disease Surveillance in Three New York State Emergency Departments

Background: Gonococcal and chlamydial associated pelvic inflammatory disease (PID) is under-reported because diagnosis is not lab-based and reporting forms may not capture PID diagnoses.

Objectives: Pilot an enhanced PID surveillance tool for chlamydia and gonorrhea cases seen in emergency departments (EDs).

Methods: Review medical records (MRs) for all female gonorrhea and chlamydia cases reported to county health departments in January – December 2009 from two Erie County EDs (ED-1 and ED-2) and July – December 2009 in one Onondaga County ED (ED-3).  Cases were classified as PID if at least one of the following criteria was documented: (1) physical exam findings consistent with CDC PID criteria; (2) provider diagnosis of PID; or (3) treatment consistent with PID.

Results: The mean ages of the ED-1, ED-2, and ED-3 patient samples were 22.9 years (SD = 6.7 years, 17.6 years (SD = 2.4 years), and 19.0 years (SD = 3.3 years), respectively.  Among chlamydia and gonorrhea ED cases reviewed, exam findings were consistent with PID in 16.1% (19/118) at ED-1, 14.1% (14/99) at ED-2, and 26.8% (11/41) at ED-3. However, PID diagnosis only appeared in the medical record in 84.2% (16/19) at ED-1, 64.3% (9/14) at ED -2, and 45.4% (5/11) at ED-3; therefore, 15.8% (3/19) of PID cases was missed at ED-1, 35.7% (5/14) at ED-2, and 54.6% (6/11) at ED-3. Among cases with PID exam findings, treatment followed CDC guidelines for 31.6% (6/19) at ED-1, 28.6% (4/14) at ED-2, and 18.2% (2/11) at ED-3.

Conclusions: The enhanced PID surveillance tool was effective in large, busy EDs, but many cases with exam findings consistent with PID were missed and inadequately treated.

Implications for Programs, Policy, and Research: ED provider training to diagnose and treat PID is needed.