Reviewer's report 
 The clinical diagnosis of Pelvic Inflammatory Disease--symptoms and signs in 189 patients visiting a Title: 
Swedish university hospital emergency department 
 2  22 May 2006 Version: Date: 
 WILLIAM RISSER Reviewer: 
Reviewer's report: 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
This is a potentially interesting paper. 
I think that the authors should concentrate on discussing what the MDs are doing correctly and incorrectly in 
their evaluation of PID rather than presenting a more general paper that discusses this but also presents a 
lot of clinical information on the patients. The presentation and diagnosis of PID and the characteristics of 
patients is not new information. 
They can discuss: 
That the MDs are using bimanual exams to diagnose PID correctly, in accordance with CDC guidelines (this 
organization is called the Centers for Disease Control and Prevention) 
That they are failing to test for chlamydia and gonorrhea and why this may be bad. They should discuss at 
this point the need to treat partners for both organisms whatever the test results on the patients. If they have 
data on whether the patients were told to ask their partners to get treated, this would be interesting to 
include. 
That ultrasound is being overused. It doesnâ €™t help much in ruling in or out mild to moderate PID and it is 
unlikely that the clinicians were worried about other diagnoses that require US in 82% of these patients 
Other clinical data on the patients could be summarized briefly, but they donâ €™t need nearly as much 
other information and the tables are too detailed and too long. For example, the data on age and length of symptoms can be presented with fewer categories or with means with standard deviations and ranges. C-reactive protein results can be presented as normal or elevated; and the sonographic results can be 
discussed in a sentence or two summarizing the significance of the cysts and the fluid. 
In the discussion, they then should compare their findings with expert opinion on the use of ultrasound to 
diagnose PID; and any other reports that they can find on physiciansâ €™ behavior in using accepted 
guidelines for diagnosing PID. 
The paper is much too long. If they use the above approach, they can tighten it up considerably. For 
example, there is much too much information about the OGED. They would benefit from having the editorial 
help of an experienced writer of clinical manuscripts. 
They can discuss: 
That the MDs are using bimanual exams to diagnose PID correctly, in accordance with CDC guidelines (this 
organization is called the Centers for Disease Control and Prevention) 
That they are failing to test for chlamydia and gonorrhea and why this may be bad. They should discuss at 
this point the need to treat partners for both organisms whatever the test results on the patients. If they have 
data on whether the patients were told to ask their partners to get treated, this would be interesting to 
include. That ultrasound is being overused. It doesnâ €™t help much in ruling in or out mild to moderate PID and it is 
unlikely that the clinicians were worried about other diagnoses that require US in 82% of these patients 
Other clinical data on the patients could be summarized briefly, but they donâ €™t need nearly as much 
other information and the tables are too detailed and too long. For example, the data on age and length of 
symptoms can be presented with fewer categories or with means with standard deviations and ranges. 
C-reactive protein results can be presented as normal or elevated; and the sonographic results can be 
discussed in a sentence or two summarizing the significance of the cysts and the fluid. 
In the discussion, they then should compare their findings with expert opinion on the use of ultrasound to 
diagnose PID; and any other reports that they can find on physiciansâ €™ behavior in using accepted 
guidelines for diagnosing PID. 
The paper is much too long. If they use the above approach, they can tighten it up considerably. For 
example, there is much too much information about the OGED. They would benefit from having the editorial 
help of an experienced writer of clinical manuscripts. 
neral 
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 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of limited interest Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I delcare that I have no competing interests.