A RETROSPECTIVE REVIEW OF POSITIVE CHLAMYDIAL CULTURES IN EMERGENCY DEPARTMENT PATIENTS

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.