The recent article by Benaim et al1 begs for a response because of the way that it negatively depicts the American Academy of Pediatrics Section on Pediatric Emergency Medicine, of which I am a member. The central thesis of their study is that pediatric emergency medicine physicians fail to comply with "CDC [Centers for Disease Control and Prevention] guidelines related to hospital admission for PID [pelvic inflammatory disease], postdiagnosis counseling, and timing of follow-up care."1(p451) They base their study, performed in 1995, on the CDC "Pelvic Inflammatory Disease: Guidelines for Prevention and Management,"2 published in 1991. The authors found that, in contrast to the recommendation contained in the guidelines that all adolescents diagnosed with PID be admitted for parenteral antibiotics, only 45% of physicians interviewed routinely admit all adolescents. Even if we are willing to accept that responses from 54 (8%) of 659 members adequately represents the entire section, there are several flaws in their argument. The authors treat the CDC guidelines as if they represent standards of care and strongly imply that deviations from these guidelines are inappropriate. The CDC document itself contradicts this approach when it states that "Recommendations in this document should be considered a source of guidance to health practitioners" and "Currently, no data are available to adequately assess the risks, benefits, and costs of inpatient versus outpatient treatment for PID." Furthermore, in many institutions, the decision to treat an adolescent with PID as an inpatient or as an outpatient is made by the emergency physician in consultation with an adolescent medicine physician. So, it may not be only pediatric emergency medicine physicians who do not adhere to the 1991 CDC guidelines, but adolescent medicine physicians as well. Would the results of a telephone survey of 8% of adolescent medicine physicians yield similar results? The criticism that only 54% of those who treat adolescents with PID as outpatients recommend follow-up care within 72 hours is a legitimate one.
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