Diagnostic accuracy of pelvic imaging for acute pelvic inflammatory disease in an emergency care setting: a systematic review and meta-analysis

Yuji Okazaki; Yasushi Tsujimoto; Kohei Yamada; Takashi Ariie; Shunsuke Taito; Masahiro Banno; Yuki Kataoka; Yoshiaki Tsukizawa

doi:10.1002/ams2.806

Diagnostic accuracy of pelvic imaging for acute pelvic inflammatory disease in an emergency care setting: a systematic review and meta-analysis

Acute Med Surg. 2022 Nov 9;9(1):e806. doi: 10.1002/ams2.806. eCollection 2022 Jan-Dec.

Authors

Yuji Okazaki^{1

2}, Yasushi Tsujimoto^{2

3

4}, Kohei Yamada⁵, Takashi Ariie^{2

6}, Shunsuke Taito^{2

7}, Masahiro Banno^{2

8

9}, Yuki Kataoka^{2

10

11

12}, Yoshiaki Tsukizawa¹³

Affiliations

¹ Department of Emergency Medicine Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan.
² Scientific Research Works Peer Support Group (SRWS-PSG) Osaka Japan.
³ Oku Medical Clinic Osaka Japan.
⁴ Department of Health Promotion and Human Behavior Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University Kyoto Japan.
⁵ Department of Traumatology and Critical Care Medicine National Defense Medical College Hospital Saitama Japan.
⁶ Department of Physical Therapy, School of Health Sciences at Fukuoka International University of Health and Welfare Fukuoka Japan.
⁷ Division of Rehabilitation, Department of Clinical Practice and Support Hiroshima University Hospital Hiroshima Japan.
⁸ Department of Psychiatry Seichiryo Hospital Nagoya Japan.
⁹ Department of Psychiatry Nagoya University Graduate School of Medicine Nagoya Japan.
¹⁰ Section of Clinical Epidemiology, Department of Community Medicine Kyoto University Graduate School of Medicine Kyoto Japan.
¹¹ Department of Internal Medicine Kyoto Min-Iren Asukai Hospital Kyoto Japan.
¹² Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health Kyoto University Kyoto Japan.
¹³ Department of Obstetrics and Gynecology Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan.

Abstract

The aim of this review is to investigate the diagnostic accuracy or performance of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) for acute pelvic inflammatory disease (PID) in an emergency care setting. We searched for studies on the diagnostic test accuracy of contrast-enhanced CT or MRI for women of reproductive age with acute abdominal pain using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and ClinicalTrials.gov. The reference standard was gynecological examinations by gynecologists using standard diagnostic criteria with or without laparoscopy or transcervical endometrial biopsy. Two reviewers undertook screening of records, data extraction, and assessment of the risk of bias in each included study using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate model was used for the meta-analysis. Of 2,619 screened studies, three studies investigating contrast-enhanced CT and one study investigating MRI were eligible, including a total 635 patients and with a median prevalence of acute PID of 29%. All of the included studies had a high risk of bias for a reference standard and had some applicability concerns. Contrast-enhanced CT had a pooled sensitivity of 0.79 (95% confidence interval [CI], 0.52-0.93) and specificity of 0.99 (95% CI, 0.94-1.00). Magnetic resonance imaging had a sensitivity of 0.95 (95% CI, 0.76-1.00) and specificity of 0.89 (95% CI, 0.52-1.00). Contrast-enhanced CT might serve as a practical alternative to gynecological examination in the diagnosis of acute PID in an emergency care setting, however, the evidence was uncertain. The evidence on MRI was also very uncertain.

Keywords: Acute pelvic inflammatory disease; contrast‐enhanced computed tomography; diagnostic accuracy; magnetic resonance imaging; systematic review and meta‐analysis.

Publication types

Review