Background Pelvic inflammatory disease is difficult to diagnose; dependent on interpretation of clinical symptoms and signs that lack sensitivity and specificity. Differences in the rates of PID diagnoses have been noted among senior sexual health physicians. Given the potential severe consequences of untreated PID, we hypothesised that clinicians with less training and experience may tend to err on the side of caution and be more likely to diagnose PID than more senior colleagues.
Objectives To ascertain whether the rates of PID diagnoses differ by grade of clinician.
Methods Women attending our service as new or rebook patients between March 2009 and January 2010 were seen by eight different grades of clinician. Of these, all but Band five nurses saw symptomatic patients. Data were analysed by grade of staff conducting the consultation.
Results Chlamydia (CT) prevalence was broadly similar across all staff groups. The rates of PID diagnoses were also similar. However, the proportion of PID patients with CT differed significantly between staff groups. In the cases of PID diagnosed by more experienced staff, CT was found in 24% to 32% of patients. This is broadly consistent with the current understanding of PID aetiology. PID diagnosed by nurses and more junior doctors was less likely to have a confirmed STI aetiology. The rate ratio of diagnosis of CT positive to CT negative PID by consultants vs Band six nurses is 5.43 (95% CI 0.77 to 38.01) p=0.089 The rate ratio of diagnosis of CT positive to CT negative PID by experienced doctors (GP, SAS, Registrar, Consultant) vs nurses, FY1 and ST2 doctors is 3.09 (95% CI 1.01 to 9.43) p=0.048 (see abstract O6 table 1).
Conclusions Significant differences were found in the proportion of patients with chlamydia positive PID between experienced doctors and other clinicians. The broader experience of senior doctors may help them in differentiating PID from other causes of lower abdominal pain thus improving the specificity of their diagnosis.
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