RECOGNITION OF TUBE-OVARIAN ABSCESS IN ADOLESCENTS WITH PELVIC INFLAMMATORY DISEASE

Purpose: Ultrasonography of the pelvis is commonly used to diagnose tu be-ovarian abscess (TOA) in patients with pelvic inflammatory disease (PID). Our objective was to determine whether the clinical features of PID differ in adolescents with and without TOA. Methods: A retrospect ive design was used to derive and validate a clinical model differenti ating adolescents with PID who did and did not have TOA. The study pop ulation consisted of hospitalized adolescents with a discharge diagnos is of PID. Of the 208 patients discharged from January 1, 1990, to Jul y 31, 1993, 87 (42%) met published criteria for PID and comprised the derivation set. Of the 63 patients from August 1, 1993, to June 24, 19 94, 30 (48%) met criteria and comprised the validation set. All patien ts had pelvic ultrasonography performed during hospitalization. The ul trasonographic records were reviewed retrospectively for TOA, ovarian and uterine size, clarity of tissue planes, and endometrial or cul-de- sac fluid. Medical records were reviewed for sociodemographic characte ristics, medical and sexual history, physical examination, laboratory results, and hospital course. Results: TOA was present in 17% of the d erivation set and 20% of the validation set. A six-variable model deve loped on the derivation set performed best in differentiating the TOA and non-TOA groups: last menstrual period >18 days prior to admission (60% and 17%), previous PID (53% and 22%), palpable adnexal mass (13% and 3%), white blood cell count greater than or equal to 10,500/mu l ( 33% and 64%), erythrocyte sedimentation rate >15 mm/h (33% and 64%), a nd heart rate >90/min (40% and 78%). In the derivation and validation sets, the model correctly identified 78 and 83% of the TOA groups and 88 and 77% of the non-TOA groups. The area under the receiver operatin g characteristic curve of the model was 0.92 in the derivation set and 0.87 in the validation set. Conclusions: We conclude that clinical ch aracteristics help identify adolescents with acute PID who have TOA. T hese: patients may have fewer signs of acute illness than those withou t TOA and may develop symptoms later in the menstrual cycle.