Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease

OBJECTIVE: Careful detection and treatment of pelvic inflammatory disease a re essential for the prevention of adverse sequelae. The purpose of this st udy was to evaluate the diagnostic test characteristics of clinical criteri a for the diagnosis of pelvic inflammatory disease. STUDY DESIGN: We performed a cross-sectional analysis of the baseline chara cteristics of 651 patients enrolled in a multicenter randomized treatment t rial for pelvic inflammatory disease. Clinical and laboratory findings were recorded for all patients, and endometrial sampling was performed. We calc ulated sensitivity and specificity and performed receiver operating charact eristic curve analysis and multivariate logistic regression, using histolog ic endometritis as the criterion standard. RESULTS: The minimal criteria for pelvic inflammatory disease, as recommend ed by the Centers for Disease Control and Prevention, had a sensitivity of 83%, in comparison with a 95% sensitivity for adnexal tenderness (P =.001). Of the supportive clinical criteria, the finding most highly associated wi th endometritis was a positive test result for Chlamydia trachomatis or Nei sseria gonorrhoeae (adjusted odds ratio, 4.3; 95% confidence interval, 2.89 -6.63). A multivariate logistic regression model indicated that combination s of criteria significantly improve the prediction of endometritis. CONCLUSION: Sensitivity can be maximized by using the presence of adnexal t enderness as a minimal criterion for the diagnosis of pelvic inflammatory d isease, and supportive criteria are helpful in estimating the probability o f endometritis.