The utility of wet prep in predicting Neisseria gonorrhoeae and Chlamydia trachomatis.

BACKGROUND: Diagnosing Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cervical infections can be difficult in the Emergency Department without real-time testing, as historical and physical elements are known to be unreliable. OBJECTIVE: To evaluate the utility of the vaginal wet mount preparation (wet prep) in predicting an infection with NG or CT. METHODS: A retrospective chart review was performed on 12 months of data from September 2007 to August 2008 on patients aged 18 years and above who had a chief complaint requiring a pelvic examination and had concurrent testing for NG/CT and a wet prep. Wet preps were analyzed and reported as quantity of white cells and clue cells present (none, few, moderate, or many) as well as the presence of Trichomonas vaginalis (TV). Wet prep results were evaluated to see if there was a correlation with NG/CT. RESULTS: There were 2439 patient encounters reviewed. A total of 373/2439 (15.3%) patient encounters were positive for NG or CT; 272/2439 (11.2%) were positive for TV, whereas 966/2439 (39.6%) had white cells and 995/2439 (40.8%) had clue cells on wet prep. Clue cells and TV did not correlate with the presence of NG or CT. Only the presence of "moderate" and "many" white cells correlated with NG or CT (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.12-2.22 and OR 2.47, 95% CI 1.86-3.27, respectively). CONCLUSION: In patients who are diagnosed with NG or CT, the presence of TV or clue cells on wet prep is an unreliable marker for diagnosis. However, having moderate or many white cells present on wet prep does increase the probability of concurrent NG or CT infection and may be used in cases where the clinical suspicion is equivocal.

Answering the myth: use of emergency services on Friday the 13th.

OBJECTIVE: The aim of the study was to evaluate the risk of Friday the 13th on hospital admission rates and emergency department (ED) visits. METHODS: This was a retrospective chart review of all ED visits on Friday the 13th from November 13, 2002, to December 13, 2009, from 6 hospital-based EDs. Thirteen unlikely conditions were evaluated as well as total ED volumes. As a control, the Friday before and after and the month before and after were used. χ(2) Analysis and Wilcoxon rank sum tests were used for each variable, as appropriate. RESULTS: A total of 49 094 patient encounters were evaluated. Average ED visits for Friday the 13th were not increased compared with the Friday before and after and the month before. However, compared with the month after, there were fewer ED visits on Friday the 13th (150.1 vs 134.7, P = .011). Of the 13 categories evaluated, only penetrating trauma was noted to have an increase risk associated with Friday the 13th (odds ratio, 1.65; 95% confidence interval, 1.04-2.61). No other category was noted to have an increase risk on Friday the 13th compared with the control dates. CONCLUSIONS: Although the fear of Friday the 13th may exist, there is no worry that an increase in volume occurs on Friday the 13th compared with the other days studies. Of 13 different conditions evaluated, only penetrating traumas were seen more often on Friday the 13th. For those providers who work in the ED, working on Friday the 13th should not be any different than any other day.