Referentie

Type studie

Kenmerken

(studie/

patiënten)

Test (T)

Controle (C)

Uitkomst maten en follow-upduur

Resultaten

Beoordeling kwaliteit studie aan de hand van CBO-formulier I, diagnostische test.

Bewijsniveau

Peiper

t 2001

Cross-

sectional

analysis

N = 651

(uit de

Peach, rct)

Objective: to evaluate the

diagnostic test characteristics of

the accepted minimal criteria for

the diagnosis of PID and to assess

the characteristics of some

additional criteria used to support

the diagnosis.

Inclusion:

1) suspected pelvic inflammatory

disease on the basis of

complaints of acute pain.

2) A clinical finding of pelvic

tenderness

3) Evidence of lower genital tract

inflammation (leucorrhea,

mucopurulent cervicitis,

positive test results for

untreated infection with N.

gonorrhoeae/C. trachomatis)

Exclusion criteria included: a

positive result on a sensitive

pregnancy test, inability to tolerate

oral antibiotic therapy, a

diagnosed or suspected

tuboovarian abscess, a surgical

emergency (eg, appendicitis or

suspected adnexal torsion), severe

allergy to penicillins,

cephalosporins, or tetracyclines,

antimicrobial therapy within 7

days before presentation, delivery,

abortion, or gynecologic surgery

within the past 30 days, prior

hysterectomy, bilateral

salpingectomy, or tubal ligation,

and homelessness.

CDC minimal clinical

criteria:

- abdominal

tenderness

- cervical motion

tenderness

- uterine tenderness

- adnexal tenderness

- CDC minimal

criteria

-temperature

-presence of rebound

or guarding

-presence of bacterial

vaginosis by clinical

criteria and gram

stain

-presence of

trichomonas on

saline solution wet

preparation

-leucorrhea ( greater

number of

leukocytes than

epithelial cells in at

least 4 high-power

fields of a saline

solution wet prep.)

- mucopurulent

cervicitis

-Abnormal cervical of

vaginal discharge

-Elevated leukocyte

count

-Positive result PCR

for Chlamydia/

gonorrhoeae

Histologic endometritis

as the criterion standard

Diagnostic test characteristics such

as sensitivity and specificity were

calculated for both the CDC criteria

and

additional supportive criteria.

Univariate odds ratios provided an

estimate of the degree to which the

relative probability of disease over

nondisease was increased on

observation of a positive criterion.

Receiver operating characteristic

curves were constructed for various

diagnostic

criteria, and the areas under these

curves were calculated to provide an

overall summary of a criterion’s

diagnostic accuracy. Multivariate

logistic regression analysis was used

to assess the direct effect of the

criteria, with adjustment

for possible additional criteria.

Various models were considered, and

models were chosen on the basis of a

combination of scientific and

statistical criteria. Standard

model checking techniques were

used. Finally, the areas under the

ROC curves were used to estimate

the predictive value of various

criteria and the final regression

model.

Prevalence histologic endometritis: 47.7%.

- abdominal tenderness, sens: 93.9 (95% CI 90.6 —

96.3), spec: 7.4

- cervical motion tenderness, sens: 91.6 (95% CI

88.0 - 94.5). spec: 12.6

- uterine tenderness, sens: 94.2 (91.0 — 96.6), spec:

5.3

- adnexal tenderness, sens: 95.5 (92.6 — 97.5), spec:

3.8

- CDC minimal criteria, sens: 83.3 (78.7 — 87.3),

spec 21.8

Supportive criteria:

- Abdominal cervical or vaginal discharge, sens: 79.7

(74.6 — 84.2), spec: 29.8 (24.8 — 35.2)

- Elevated temperature (>100.4 F) sens: 11.1 (7.8 —

15.2), spec: 94.6 (91.7 — 96.9)

- Elevated leukocyte count (> 10,000 cells), sens:

41.1 (35.1 — 47.3)

- Positive bacterial test results, sens: 56.0 (50.2 —

61.6), spec: 81.6 (77.0 — 85.6)

The full model of the study, incorporating

temperature, vaginal and cervical discharge,

leukocyte count, and testing for N. gonorrhoeae

and Chlamydia could correctly identify diseased

patients only 72% of the time.

The authors propose adnexal tenderness as the

minimal criterion for a diagnosis of upper genital

tract infection, because this clinical sign had the

greatest sensitivity.

- Valide referentietest: +

- Index- en referentietest

blind van elkaar beoordeeld:

?

- indextest afgenomen

onafhankelijk van andere

informatie over ziektestatus:

+

- beslissing om de

referentietest uit te voeren

onafhankelijk van de uitslag

van de Indextest: -

- referentietest toegepast

voordat op basis van de

resultaten van de indextest

reeds

een behandeling is gestart: +

- selectie van patiënten voor

het onderzoek valide: ? (niet

opeenvolgend en na

includeren van 58 ptn werd

een extra inclusiecriterium

toegevoegd)

- toepasbaarheid: +

Algemeen eindoordeel:

matig/ voldoende

A2

Gaitan

2002

Cross-

sectional

analysis

N = 61 (31

with PID

and 30

with

another

cause for

non-

specific

lower

abdominal

pain

(NSLAP)

Objective: To evaluate the clinical

diagnosis of pelvic inflammatory

disease (PID) compared with the

diagnosis of

PID made by laparoscopy,

endometrial biopsy, transvaginal

ultrasound, and cervical and

endometrial cultures.

Inclusion criteria:

Patients with NSLAP

Exclusion criteria:

signs of generalized peritonitis,

prior intestinal surgery, shock,

chronic pelvic pain, viable

intrauterine pregnancy, weight

over 100 kg and current/previous

psychiatric problems.

Diagnosis provided by

an evaluated method:

- lower abdominal

pain, bilateral adnexal

tenderness, cervical

motion pain on

bimanual

examination,

abnormal vaginal

discharges, lower back

pain, menstrual cycle

irregularity, dysuria,

painful sexual

intercourse, body

temperature >38 °C,

WBC count

>10X109/L 48.1,

CRP >10 mg/L,

trachomatis in

endocervical canal, N.

gonorrhoeae in

endocervical canal, C.

trachomatis in

fallopian tubes, N.

gonorrhoeae in

fallopian tubes

At least 2 Hager’s

criteria):

(a) Sight of purulent

material in the upper

genital tract and/or

ovaries, or the presence

of pus on the peritoneal

surface at the bottom of

the posterior sack and

uterus

(b) The presence of

chronic endometritis,

according to Kiviat’s

criteria

(c) Cultures positive for

Neisseria gonorrhoeae or

Chlamydia trachomatis in

the cervix or

endometrium, or by the

presence of aerobic or

anaerobic bacteria, N.

gonorrhoeae,

mycoplasma or

ureaplasma in the

endometrium

(d) Presentation of acute or chronic salpingitis in

pathology

The model’s predictive capacity was

evaluated through specificity,

sensitivity, positive and negative

predictive values, and the ROC

curve.

- Adnexal tenderness, sens: 93, spec: 6

- Cervical motion tenderness, sens: 63, spec: 40

- Purulent endocervical secretion, sens: 23, spec: 93

- Vaginal discharge, sens: 40, spec: 73

- Leukocyte count greater than

10 500/mm3, sens: 35, spec: 70

- Neutrophyl count greater than 80%, sens: 26,

spec: 80

- Abdominal rebounding pain, sens: 25, spec: 90

It was found that the best prediction model for PID

in patients presenting with NSLAP was that

involving the following variables: younger than 20

years old; current use of IUD; purulent endocervical

secretion; and negative pregnancy test.

The area below the ROC curve was 0.83. This

model has 69% sensitivity, 88% specificity,

86% positive predictive value, 74% negative

predictive

value, 79% accuracy, and 50% prevalency

- Valide referentietest: + /-

er worden vier verschillende

testen gebruikt.

- Index- en referentietest

blind van elkaar beoordeeld:

? patholoog is geblindeerd,

niet duidelijk of de personen

die de laparoscopie

uitvoeren en beoordelen

geblindeerd zijn.

- indextest afgenomen

onafhankelijk van andere

informatie over ziektestatus:

+

- beslissing om de

referentietest uit te voeren

onafhankelijk van de uitslag

van de indextest: +

- referentietest toegepast

voordat op basis van de

resultaten van de indextest

reeds

een behandeling is gestart: +

- selectie van patiënten voor

het onderzoek valide: +

- toepasbaarheid: ?

Algemeen eindoordeel: matig

B

Morco

s 1993

Cross

sectional

analysis

(chart

review)

N = 176

All patients presenting to Medical

Center in Youngstown, Ohio

between January 1983 and June

1990 with a clinical diagnosis of

PID.

Excl:

Patients presenting with recurrent

PID whose prior episode was

laparoscopically confirmed.

- 21 clinical

indicators:

Abdominal pain,

fever or chills,

abnormal vaginal

bleeding, cervical

motion tenderness,

adnexal tenderness,

adnexal mass,

nausea or vomiting,

abdominal rebound

Laparoscopic findings of

PID:

- Stage 1, Stage 2 and

Stage 3

A statistical analysis of association

between PID and each of the 21

potential PID indicators.

PID was established laparoscopically in 134 (76.1%)

of the patients.

The optimal set of indicators for classifying

suspected cases as PID or non-PID were adnexal

tenderness (present or absent), duration of any one

symptom (less than one week or more) and white

blood cell count (actual value). This model has a

sensitivity of 86.6% and a specificity of 45.7%. The

predictive values of positive and negative tests are

estimated to be 0,84 and 0,52 resp.

- Valide referentietest: +

- Index- en referentietest

blind van elkaar beoordeeld:

?

- indextest afgenomen

onafhankelijk van andere

informatie over ziektestatus:

-

- beslissing om de

referentietest uit te voeren

onafhankelijk van de uitslag

B

tenderness, guarding, urinary symptoms, symptoms of proctitis, history of PID or sexually transmitted diseases, amenorrhea and duration of symptoms. White blood cell count, percentage of neutrophils and bands, hemoglobin and hematocrit level, cervical culture for N. gonorrhoeae and Chlamydia immunofluorescent test. Univariate test of significant association with PID resulted in P< .20.

The performance of the model is about the same when it is used to discriminate between stages of PID’s and non-PID.

van de indextest: -

-  referentietest toegepast voordat op basis van de resultaten van de indextest reeds

een behandeling is gestart: +

-  selectie van patiënten voor het onderzoek valide: +

- toepasbaarheid: +

Algemeen eindoordeel: matig, gepresenteerde data zijn sumier

Cibula

2001

Prospectiv e cohort study/ or cross sectional?

N = 141 patients

Objective: To evaluate the accuracy of the clinical diagnosis of recurrent pelvic inflammatory disease (PID) and to determine the positive and negative predictive value of laboratory tests for the diagnosis of PID.

Investigation was conducted between Jan 1995 and Feb 1999

Inclusion: a history of at least one episode of PID, hospitalization with the clinical diagnosis of PID. Minimum criteria for inclusion were lower abdominal pain and adnexal tenderness or a painful adnexal mass

Excl: women who had had abdominal surgery four weeks prior to admission and women receiving antibiotics within the previous two weeks.

Endocervical specimens: aerobic and anaerobic bacteria,

- endocervical and urethral: Chlamydia (PCR) and N. gonorrhoeae White blood cell count, erythrocyte sedimentation rate (ESR) and CRP.

All patients underwent laparoscopy.

Groups were defined:

1) confirmed laparoscopy

2) other findings.

PID was categorized: mild/ moderate/ severe

The positive predictive value (PPV) and negative predictive value (NPV) of the laboratory tests for establishing the diagnosis of PID were evaluated by comparing the results in the two patients groups.

The clinical diagnosis of PID was confirmed by laparoscopy in 30% of patients.

In 13 (9%) patients laparoscopy disclosed a variety of pelvic pathology (ovarian cysts, subserous myoma, polycystic ovaries, appendicitis).

Table II PPV and NPV of Observed Parameters in Diagnosit PID

Parameter                                                    PPV (%)      NPV

ESR£15mm/h                                                  62.5              59

CRPnSmg/dL                                                  91.5              28

WBCn1Q,000/pL                                             95.1              15

Temperaturen 37,2^ÖC                                      85.6              19

Aerobic and anaerobic culture                        28.0              57

Isolation of C trachomatis                               82.0              25

ESR vs. CRP vs. WBC^a                                 40.5              66

ESR vs. CRP vs. WBC vs. temperature³       53.7              77

^aAt least one parameter positive.

According to the authors: neither the individual monitored parameters nor their combination reached satisfactory positive and negative predictive values for diagnosing PID.

- Valide referentietest: +

-  Index- en referentietest blind van elkaar beoordeeld: ?

- indextest afgenomen onafhankelijk van andere informatie over ziektestatus:

"-

- beslissing om de referentietest uit te voeren onafhankelijk van de uitslag

, van de indextest: +

-  referentietest toegepast voordat op basis van de resultaten van de indextest reeds

een behandeling is gestart: +

-  selectie van patiënten voor he t onderzoek valide: +

- toepasbaarheid: + /-

A2?

Maleki

ene

2008

Prospectiv e cohort/ cross- sectional

N = 73

The aim of the present study was to prospectively evaluate the risk factors, clinical diagnostic criteria, and laparoscopic findings in women with PID

Inclusion criteria: Women admitted to the gynecology department with clinically suspected PID. All women reported lower

abdominal pain, bilateral adnexal tenderness, and cervical motion pain

on bimanual examination.

Exclusion criteria:

Not defined.

Lower abdominal pain, Bilateral adnexal tenderness, Cervical motion pain on bimanual examination, Abnormal vaginal discharges, Lower back pain, Menstrual cycle irregularity, Dysuria, Painful sexual intercourse, Body temperature >38 °C, WBC count >10X109/L,

CRP >10 mg/L, C. trachomatis in endocervical canal, N. gonorrhoeae in endocervical canal, C. trachomatis in fallopian tubes 23.1, N. gonorrhoeae in fallopian tubes

All patients underwent diagnostic laparoscopy.

The sensitivity, specificity, and positive and negative predictive values of the main clinical diagnostic criteria in patients

with laparoscopically confirmed PID.

The diagnosis was confirmed with laparoscopy in 52 patients (71,2%). Other diagnoses: acute appendicitis (3), endometriosis (5), ruptured ovarian cysts (4) normal pelvis (9).

(NB: all women reported lower abdominal pain, bilateral adnexal tenderness and cervical motion pain on bimanual examination)

Sensii iviiy. spetificiiy. and positive and negative predictive values of dinical d criteria in patients with laparoscopicallyconfirmed pelvic inflammatory disea

Signa and sympioms                                            Stnsitivity (*> Specifidty (*} PPV(%)

Lower abdominal pain                                        100                                      0                                 71

Bilateral adnexal tenderness                       100                                      0                                 71

cervical motion pain on                                      100                                    0                                 71

bimanual examination

Abnormal vaginal discharges                         596                                   762                              86

Lower back pain                                                      73.1                                 80.9                              904

Menst rual cycle irregularity                           64.6                                 66.7                              813

Dysuria                                                                           51.9                                 85.7                             90

fcinful sexual intercourse                                269                                  38.1                              823

Body temperature ï38 T                                       25                                     80.9                              765

WBC count 210*10%                                            48.1                                  763                              833

CKPïlOmg/L                                                                  75                                     52.4                              796

C. trodwruoos in endocervical canal 46.2                                         80.9                             85.7

N. gononften inendocervical canal                   269                          100                               I0O

C. tradiomnris in fallopian tubes                         23.1                         100                               100

N. gononhea in faDopian tubes                              1.9                         100                              100

Abbreviations: PFV, positive piedictive value: NPV, negative predictive vali white Wood eell: CRP, C-reactlve protein.

-  Valide referentietest: ? criteria als bevindingen bij laparoscopie niet helder beschreven.

- Index- en referentietest blind van elkaar beoordeeld:

?

O'

0

-     indextest afgenomen 45.2

onafhankelijk van andere 321

informatie over ziektestatus: 372 ?

37.7

35.6

34.4

beslissing om de e: WBC.

referentietest uit te voeren onafhankelijk van de uitslag van de indextest: -

-  referentietest toegepast voordat op basis van de resultaten van de indextest reeds een behandeling is gestart: ?

-  selectie van patiënten voor het onderzoek valide: +- toepasbaarheid: +/-

Algemeen eindoordeel: slecht

B

Short

2009

N = 722

(uit de Peach, rct)

Objective: To examine the characteristics of mycoplasma genitalium infection among women with N. gonorrhoeae monoinfection or C. trachomatis infection,

Pos M. genitalium PCR.

Potential characteristics: elevated oral temperature (38.3 C), elevated WBC count (110,000 cells/mL), elevated erythrocyte sedimentation rate (115 mm/h), elevated C-reactive protein level (5 mg/dL), bilateral adnexal tenderness, mucopurulent cervicitis, and bacterial vaginosis (BV), defined using Gram stain and Amsel’s criteria Symptoms at presentation that were evaluated as potential characteristics of M. genitalium infection included the following: nausea or vomiting,

nonmenstrual vaginal bleeding or spotting, more-prolonged or heavier menstrual bleeding, vaginal bleeding during or after sex, abnormal vaginal discharge, increased frequency of urination, and overall self-rated pelvic pain

Vs. pos N. gonorrhoeae or Chlamydia PCR.

Compared with women with gonococcal PID, women with M. genitalium infection were less likely to have elevated systemic inflammatory markers, including an erythrocyte sedimentation rate >15 mm/h (5 [22.7%] of 22 patients vs. 45 [60.8%] of 74 patients; P =0.002), a white blood cell count >10,000 cells/mL (4 [28.6%] of 14 patients vs. 42 [64.6%] of 65 patients; P =0.018), and an oral temperature > 38.3°C (0 [0.0%] of 22 patients vs.

10 [13.9%] of 72 patients; P = 0.085). In addition, they were less likely to present with mucopurulent cervicitis (9 [47.4%] of 19 patients vs. 60 [83.3%] of 72 patients; P = 0.001), elevated vaginal pH (P = .018), and high pelvic pain score (P= .014).

In contrast, women with chlamydial PID had signs and symptoms that were similar to those in women with M. genitalium infection.

Risser

2009

‘structured’

review.

Objective: to evaluate purulent vaginal and cervical discharge as a diagnostic test for pelvic inflammatory disease (PID).

Pretest probability of 50% was used (diagnosed clinically)

excess leukocytes in vaginal or cervical discharge.

PID proven by laparoscopy or endometrial biopsy

For each study, we calculated the post-test probabilities of PID from the pretest probability of disease (the prevalence of PID in patients like the patient being tested) and the sensitivity and specificity of the diagnostic test, namely excess leukocytes in vaginal or cervical discharge. We calculated these probabilities using the odds- likelihood formulation of Bayes’ theorem.

The post-test probabilities of proven PID if leukocytes were

present in vaginal or cervical discharge ranged from 50% to 73%. The mean value with 95% confidence interval (CI) was 57%, 53—61% (Table 1). Therefore, given that the pretest probability was 50%, the presence of leukocytes did not increase the probability of PID enough to make this a particularly helpful test. Excluding Westrom’s thesis2,3 (whose results have not been reproduced elsewhere in the literature), the post-test probabilities of PID if leukocytes were absent ranged from 24% to 49%. The mean value with 95% CI was 39%, 35- 42%. This mean probability is large enough that PID cannot be dismissed as a possible diagnosis, given its potentially severe long­term complications if it is not adequately treated.

The authors conclude that the presence or absence of excess white blood cells in vaginal or cervical discharge was not particularly helpful in confirming or excluding PID in patients in whom the diagnosis was suspected from the clinical examination.

Systematische review, goede kwaliteit

A1

Kahn,

1991

Systematic

review

Objective: To examine the accuracy of existing diagnostic indicators for pelvic inflammatory disease and to develop guidelines for a new diagnostic model

Inclusion criteria: Subjects were generally required to have lower abdominal pain plus one to four other symptoms or signs, such as pelvic tenderness, cervical motion tenderness, elevated sedimentation rate, and fever.

All studies that quantitatively investigated the utility of discrete historical, clinical, or laboratory findings, which we termed indicators, in the diagnosis of PID.

The gold standard for these measures of diagnostic test accuracy was each study's own outcome assessment of PID diagnosis, usually laparoscopy. Two studies used broad clinical inclusion criteria and clinical criteria much more specific to PID to establish the diagnosis. Three studies used less appropriate clinical criteria.

The diagnostic indicators were organized into four categories: history (symptoms), clinical examination (signs), laboratory, and combinations of indicators.

Summary tables and graphs were prepared to facilitate comparison and assessment of different indicators.

Historical findings were usually not statistically significant predictors of pelvic inflammatory disease, and when they were they tended toward low sensitivity and high specificity, while clinical findings were somewhat more sensitive and about as specific. Several laboratory tests showed consistent value in pelvic inflammatory disease diagnosis, with high sensitivity and specificity. Combinations of indicators permitted high sensitivity or high specificity but not both simultaneously. No single or combination diagnostic indicator was found to reliably predict pelvic inflammatory disease. Combining published evidence with practical clinical considerations, a diagnostic approach is proposed that emphasizes diagnostic sensitivity when clinical presentation is mild and more thorough evaluation when a woman is severely ill.

Systematische review, redelijke kwaliteit

A1

Peiper

t

Cohort

study

Inclusion criteria: women who either met the

Serum WBC, erythrocyte

Any of the following findings: 1) histologic

Prognostic capabilities of erythrocyte sedimentation rate and C-reactive

Sensitivities for elevated white blood cell count (WBC), erythrocyte sedimentation rate, C-reactive

NB geselecteerde p atiëntenpopulatie.

1996

N = 120

Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or who had other signs of upper genital tract infection (ie, atypical pelvic pain, abnormal uterine bleeding, or cervicitis).

Exclusion criteria: postpartum or postoperative within the preceding 4 weeks, pregnancy, an inability to give informed consent, or a history of hysterectomy or bilateral salpingectomies.

sedimentation rate, and C-reactive protein

evidence of acute endometritis or salpingitis, 2)

laparoscopic visualization of purulent exudate in the pelvis without another source, or 3) positive testing for Neisseria gonorrhoeae or Chlamydia trachomatis from the endometrium, fallopian tubes, or pelvis.

protein were quantified by the area under their respective ROC curve Odds ratios were estimated using conditional maximum likelihood, and exact 95% CI are provided.

A multiple logistic regression model was used to determine which of the four tests was most strongly associated with acute upper genital tract infection.

protein, and increased vaginal white blood cells are 57, 70, 71, and 78%, respectively. If any one test is abnormal, the sensitivity is 100% and specificity is 18%. If all four tests are abnormal, sensitivity is 29% and specificity is 95%.

Opeenvolgende patiënten: ? Beide testen bij alle patiënten*: -, bij 3 patiënten geen CRP bepaald. En referentietesten verschillen Testen

onafhankelijk van elkaar beoordeeld*: ? Financiering: niet vermeld.

Studie van matige kwaliteit

Mietti

nen,

1993

Cohort

study

N = 72

Inclusion criteria:

History of abdominal pain of of < 3 weeks’duration, presence of cervical motion tenderness and uterine and adnexal tenderness on bimanual examination

Exclusion criteria:

If women had taken antibiotics, had had any gynaecologic operation or instrumentation of the upper genital tract in the preceding month, puerperal infections or pregnancy. Nonclassical symptoms and signs included atypical pain fie, of less than 30 days duration) that did not meet the CDC's minimal criteria for acute PID, abnormal uterine bleeding of unclear etiology (in women under age 40 to avoid those who were perirnenopausal) or cervicitis as demonstrated by a mucopurulent cervical discharge or a positive cervical test for N. gonorrhoeae and/or C. trachomatis.

Erythrocyte sedimentation rate and serum C-reactive protein

Assessment of salpingitis: presence of erythema and edema of the fallopian tubes and mucopurulent exudate expressed from the fimbrial end of one or both tubes. Salpingitis was graded into mild, moderate, or severe (Hager 1983).

Assessment of endometritis: endometrial biopsy, identification of plasma cells. Endometritis was classified as mild, moderat, or severe (Paavonen 1985).

Patients were pooled: Mild: -endometritis only, or — mild salpingitis with or without endometritis

(N = 37)

Severe: - pyosalpinx, TOA, perihepatitis or - other signs of severe or moderate salpingitis with or without (N = 35) endometritis.

Mean erythrocyte sedimentation rate and mean serum C reactive protein rate in patients with mild versus severe PID on admission.

Correlation between ESR and CRP.

Sensitifity, specificity, PPV and NPV for different even erythrocyte sedimentation rate and C-reactive protein values in discriminantion between patients with severe and mild PID. Cutt-off values for mild or severe PID were determined.

Erythrocyte sedimentation rate:

In patients with severe disease: 58.7 mm/hr (95%CI 48.9 - 68.5)

In patients with mild disease:

25.2 mm/hr (95% CI 19.3 - 31.0)

C-reactive protein:

In patients with severe disease:

93.8 mg/L (95%CI 73.6 - 113.9)

In patients with mild disease:

44.6 mg/L (95%CI 31.1 - 56.1)

Cutoff values for severe PID set at > 40 mm /hr (ESR) and > 60 mg/L (CRP) gave a specificity of 73% and 75%, a sensitivity of 83% and 73%, and a negative predictive value of 82% and 75%, and positive predictive value of 74% and 73%.

NB geselecteerde patiëntenpopulatie.

Opeenvolgende patiënten: ? Beide testen bij alle patiënten*: -

(referentietesten verschillen.

Testen onafhankelijk van elkaar beoordeeld*: ? Financiering: niet vermeld.

Studie van matige kwaliteit

B