L. Chan et al., A RETROSPECTIVE REVIEW OF POSITIVE CHLAMYDIAL CULTURES IN EMERGENCY DEPARTMENT PATIENTS, The American journal of emergency medicine, 14(4), 1996, pp. 406-409
This study evaluated the accuracy of diagnosis and treatment of chlamy
dial infection based solely on clinical presentation in the emergency
department (ED), The signs and symptoms of women with chlamydial infec
tion confirmed by cervical culture were identified and compared betwee
n appropriately treated and nontreated groups to determine which clini
cal features tended to lead to the correct or incorrect diagnosis, The
study also determined which signs and symptoms were consistently pres
ent in the entire study group, Two hundred thirty three charts of fema
le ED patients with positive cervical chlamydial cultures were obtaine
d via computerized records from the microbiology lab and reviewed retr
ospectively. Only 20% of the patients were correctly diagnosed as havi
ng a sexually transmitted disease and only 24% were properly treated d
uring their initial ED visit. Although abdominal pain and vaginal disc
harge were the most frequent symptom and sign, only 70% and 54% of all
patients had these clinical manifestations, respectively. Patients wi
th vaginal discharge and cervical motion tenderness were significantly
(P <.01) more likely to be treated in the ED. Patients with urinary t
ract symptoms and pregnancy were significantly (P <.01) less likely to
be treated in the ED, Cervical cultures should be performed during al
l pelvic examinations because of the variability in the clinical prese
ntation of chlamydial infection. A follow-up system must be in place t
o identify positive cultures and locate patients to ensure appropriate
treatment. Copyright (C) 1996 by W.B. Saunders Company.