Study suggests federal guidelines for treating teen PID need clarification

A Johns Hopkins Children's Center survey of 102 clinicians who treat teenage girls with pelvic inflammatory disease (PID) has found that official guidelines designed to inform decisions about hospitalization versus outpatient care leave some clinicians scratching their heads.

The study, conducted by a team of specialists and published online in the journal Sexually Transmitted Diseases, presented the clinicians with a series of common and discovered a great deal of uncertainty among some trying to choose between inpatient and outpatient treatment for PID, a potentially damaging inflammation of the resulting from untreated, undertreated or recurrent sexually transmitted infections like chlamydia and , among others.

"The current guidelines from the leave a lot of room for interpretation and uncertainty, which can lead to considerable variability in treatment choice and outcomes from patient to patient," says study lead author Maria Trent, M.D., M.P.H., a pediatrician and teen health specialist at Johns Hopkins Children's Center.

Trent says that despite data showing that teens with PID often fail to adhere to outpatient and miss follow-up appointments, the CDC no longer recommends in-hospital treatment, although clinicians have the flexibility to hospitalize patients if they so choose.

However, the Johns Hopkins study findings suggest the guidelines fall short of informing that flexibility, particularly in cases that involve patients with recent abortions or whose make it unlikely they would comply with the complex outpatient treatment, the researchers say. Such ambivalence was particularly common when the clinicians were uncertain about patients' ability to care for themselves, their willingness to take medications or about their willingness to share diagnoses with sexual partners.

Trent says the study revealed a gender and parental bias in decision-making. Male clinicians and non-parent clinicians were more likely than their female and parent colleagues to hospitalize patients, the study found.

"We found that some clinicians are simply uncomfortable sending a teen home and asking her to follow a complicated PID treatment regimen and return for follow-up visits, despite existing guidelines stating they should do just that," Trent says.

Designed properly, Trent adds, clinical guidelines should offer clear decision-making algorithms while giving physicians autonomy and flexibility. Lack of clarity, however, can force clinicians to make decisions predicated on personal bias rather than on evidence stemming from best practices, the investigators say.

In the study, the clinicians were presented with 17 clinical vignettes involving a hypothetical 15-year-old with PID, then asked to choose between hospital and outpatient treatment for each scenario. The clinicians had to weigh various factors, such as the patient's severity of illness and age, whether the patient was pregnant, whether the patient has had recent surgical procedures, whether the patient was afraid of sharing her diagnosis with a partner and whether the patient appeared able and willing to follow outpatient treatment regimen.

Each year, 800,000 girls and women in the United States develop PID, according to the CDC, and 10 percent of them develop infertility as a result. PID can lead to an array of other long-term problems including ectopic pregnancy and chronic pelvic pain, the researchers say.

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

A better biomonitor for children with asthma

Dec 10, 2014

For the firefighters and rescue workers conducting the rescue and cleanup operations at Ground Zero from September 2001 to May 2002, exposure to hazardous airborne particles led to a disturbing "WTC cough"—obstructed ...

New insight into risk of Ankylosing Spondylitis

Dec 09, 2014

Scientists at the University of Southampton have discovered variations in an enzyme belonging to the immune system that leaves individuals susceptible to Ankylosing Spondylitis.

Novel approach to treating asthma: Neutralize the trigger

Dec 03, 2014

Current asthma treatments can alleviate wheezing, coughing and other symptoms felt by millions of Americans every year, but they don't get to the root cause of the condition. Now, for the first time, scientists ...

Inflammatory discovery sheds new light on skin disease

Dec 02, 2014

Inflammatory skin diseases such as psoriasis may result from abnormal activation of cell death pathways previously believed to suppress inflammation, a surprise finding that could help to develop new ways ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.