title: National trends in pelvic inflammatory disease among adolescents in the emergency department.
abstract: OBJECTIVE
  In 2002, the Centers for Disease Control and Prevention (CDC) broadened the pelvic inflammatory disease (PID) diagnostic criteria to increase detection and prevent serious sequelae of untreated PID. The impact of this change on PID detection is unknown. Our objectives were to estimate trends in PID diagnosis among adolescent emergency department (ED) patients before and after the revised CDC definition and to identify factors associated with PID diagnoses.
  
  
  METHODS
  We performed a retrospective repeated cross-sectional study using the National Hospital Ambulatory Medical Care Survey from 2000 to 2009 of ED visits by 14- to 21-year-old females. We calculated national estimates of PID rates and performed multivariable logistic regression analyses and tests of trends.
  
  
  RESULTS
  During 2000-2009, of the 77 million female adolescent ED visits, there were an estimated 704,882 (95% confidence interval [CI], 571,807-837,957) cases of PID. After the revised criteria, PID diagnosis declined from 5.4 cases per 1,000 United States adolescent females to 3.9 cases per 1,000 (p = .03). In a multivariable model, age ≥17 years (odds ratio, 2.14; 95% CI, 1.25-3.64) and black race (odds ratio, 2.04; 95% CI, 1.36-3.07) were associated with PID diagnosis.
  
  
  CONCLUSIONS
  Despite broadened CDC diagnostic criteria, PID diagnoses did not increase over time. This raises concern about awareness and incorporation of the new guidelines into clinical practice.
authors.affiliation: Children's National Medical Center, George Washington University, Washington, DC, USA. monika.goyal217@gmail.com
authors.forename: Monika
authors.initials: M
authors.lastname: Goyal
authors.forename: Adam
authors.initials: A
authors.lastname: Hersh
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.forename: Maria
authors.initials: M
authors.lastname: Trent
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Adolescents; Pelvic inflammatory disease; Trends