Moran G J, Talan D A, Mower W, Newdow M, Ong S, Nakase J Y, Pinner R W, Childs J E
Department of Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Dr, North Annex, Sylmar, CA 91342, USA.
JAMA. 2000;284(8):1001-7. doi: 10.1001/jama.284.8.1001.
Rabies postexposure prophylaxis (RPEP) treatments and associated costs have increased in the United States. The extent to which RPEP use is consistent with guidelines is not well understood.
To characterize animal contacts and determine the frequency and factors associated with inappropriate RPEP use.
DESIGN, SETTING, AND PATIENTS: Prospective case series study of patients presenting with an animal exposure-related complaint from July 1996 to September 1998 at 11 university-affiliated, urban emergency departments (the Emergency ID Net).
Exposure type, circumstances, and RPEP use (appropriateness defined by local public health departments).
Of 2030 exposures, 1635 (81%) were to dogs; 268 (13%) to cats; 88 (4%) to rodents/rabbits; 10 (0. 5%) to raccoons; 5 (0.2%) to bats; and 24 (1.2%) to other animals. Among those exposed, 136 (6.7%) received RPEP after dog (95), cat (21), raccoon (8), bat (4), or other animal (8) exposures. Use of RPEP varied by site (range, 0%-27.7% of exposures), with most frequent use reported at sites in the eastern United States. Management was considered appropriate in 1857 exposures (91.5%). Use of RPEP was considered inappropriate in 54 cases (40% of those in which it was given), owing to factors including animal availability for observation and exposure in a low-endemicity area. Rabies postexposure prophylaxis was considered inappropriately withheld from 119 cases (6.3% of those not receiving RPEP), often because a domestic animal was unavailable for observation or testing.
These results suggest that use of RPEP is often inappropriate. Greater compliance with current guidelines would increase RPEP use. Physician education, improved coordination with public health officials, and clarification of RPEP guidelines could optimize use of this expensive resource. JAMA. 2000;284:1001-1007
美国狂犬病暴露后预防（RPEP）治疗及相关费用有所增加。RPEP的使用与指南的符合程度尚不清楚。
描述动物接触情况，确定不适当使用RPEP的频率及相关因素。
设计、地点和患者：1996年7月至1998年9月，对11家大学附属医院的城市急诊科（急诊ID网络）中因动物暴露相关投诉前来就诊的患者进行前瞻性病例系列研究。
暴露类型、情况及RPEP使用情况（适当性由当地公共卫生部门界定）。
在2030次暴露中，1635次（81%）是被狗暴露；268次（13%）是被猫暴露；88次（4%）是被啮齿动物/兔子暴露；10次（0.5%）是被浣熊暴露；5次（0.2%）是被蝙蝠暴露；24次（1.2%）是被其他动物暴露。在这些暴露者中，136人（6.7%）在被狗（95人）、猫（21人）、浣熊（8人）、蝙蝠（4人）或其他动物（8人）暴露后接受了RPEP。RPEP的使用因地点而异（范围为暴露的0% - 27.7%），美国东部地区的使用频率最高。1857次暴露（91.5%）的处理被认为是适当的。54例（占使用RPEP病例的40%）使用RPEP被认为不适当，原因包括动物可供观察以及在低流行地区的暴露等因素。119例（占未接受RPEP病例的6.3%）被认为不恰当地未给予狂犬病暴露后预防，通常是因为无法对家畜进行观察或检测。
这些结果表明RPEP的使用常常不适当。更好地遵守现行指南将增加RPEP的使用。对医生进行教育、改善与公共卫生官员的协调以及明确RPEP指南可优化这种昂贵资源的使用。《美国医学会杂志》。2000年；284:1001 - 1007
