Diagnosing pelvic inflammatory disease. A comprehensive analysis and considerations for developing a new model
J. G. Kahn, C. K. Walker, A. E. Washington, D. V. Landers and R. L. Sweet
Institute for Health Policy Studies, School of Medicine, University of California, San Francisco 94109.
OBJECTIVE.--To examine the accuracy of existing diagnostic indicators for
pelvic inflammatory disease and to develop guidelines for a new diagnostic
model. DATA SOURCES.--Studies were identified for the period 1969 through
1990. A Medline search of the English-language literature was conducted
using the subject terms pelvic inflammatory disease or salpingitis and
diagnosis. In addition, abstracts and bibliographies of articles and books
were reviewed. STUDY SELECTION.--Studies were selected if pelvic
inflammatory disease was diagnosed using laparoscopic findings or narrow
clinical rules. Of the 15 reports identified, 12 were included in this
analysis. The selected studies were grouped by a quality rating based on
subject selection, definition of pelvic inflammatory disease, data
analysis, and other measures. DATA EXTRACTION.--Diagnostic findings were
divided into four categories: historical (symptoms), clinical examination
(signs), laboratory, and combinations of the above. Sensitivity and
specificity were extracted using raw data. Data were classified by quality
rating. DATA SYNTHESIS.--Historical findings were usually not statistically
significant predictors of pelvic inflammatory disease, and when they were
they tended toward low sensitivity and high specificity, while clinical
findings were somewhat more sensitive and about as specific. Several
laboratory tests showed consistent value in pelvic inflammatory disease
diagnosis, with high sensitivity and specificity. Combinations of
indicators permitted high sensitivity or high specificity but not both
simultaneously. CONCLUSIONS.--No single or combination diagnostic indicator
was found to reliably predict pelvic inflammatory disease. Combining
published evidence with practical clinical considerations, a diagnostic
approach is proposed that emphasizes diagnostic sensitivity when clinical
presentation is mild and more thorough evaluation when a woman is severely
ill. Research is needed to evaluate the accuracy and acceptability of
specific diagnostic models and to investigate new diagnostic indicators.
