Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA.
Ann Emerg Med. 2011 Jul;58(1 Suppl 1):S17-22.e1. doi: 10.1016/j.annemergmed.2011.03.018.
Differences in the prevalence of undiagnosed HIV between different types of emergency departments (EDs) are not well understood. We seek to define missed opportunities for HIV diagnosis within 3 geographically proximate EDs serving different patient populations in a single metropolitan area.
For an urban academic, an urban community, and a suburban community ED located within 10 miles of one another, we reviewed visit records for a cohort of patients who received a new diagnosis of HIV between July 1999 and June 2003. Missed opportunities for earlier HIV diagnosis were defined as ED visits in the year before diagnosis, during which there was no documented ED HIV testing offer or test. Outcomes were the number of missed opportunity visits and the number of patients with a missed opportunity for each ED. We secondarily reviewed medical records for missed opportunity encounters, using an extensive list of indications that might conceivably trigger testing.
Among 276 patients with a new HIV diagnosis, 123 (44.5%) visited an ED in the year before diagnosis or received a diagnosis in the ED. The urban academic ED HIV testing program diagnosed 23 (8.3%) cases and offered testing to 24 (8.7%) patients who declined. Missed opportunities occurred during 187 visits made by 76 (27.5%) patients. These included 70 patients with 157 visits at the urban academic ED, 9 patients with 24 visits at the urban community ED, and 4 patients with 6 visits at the suburban community ED. Medical records were available for 172 of the 187 missed opportunity visits. Visits were characterized by the following potential testing indicators: HIV risk factors (58; 34%), related diagnosis indicating risk (7; 4%), AIDS-defining illness (8; 5%), physician suspicion of HIV (29; 17%), and nonspecific signs or symptoms of illness potentially consistent with HIV (126; 73%).
Geographically proximate EDs differ in their opportunities for earlier HIV diagnosis, but all 3 sites had missed opportunities. Many ED patients with undiagnosed HIV have potential indications for testing documented even in the absence of a dedicated risk assessment, although most of these are nonspecific signs or symptoms of illness that may not be clinically useful selection criteria.
不同类型的急诊部（ED）之间未确诊 HIV 的流行率存在差异，目前对此了解甚少。我们旨在确定在同一大都市区内，3 家地理位置相近的 ED 中，为服务不同患者人群而提供的 HIV 诊断机会的缺失情况。
在一家城市学术型 ED、一家城市社区 ED 和一家郊区社区 ED 中，我们回顾了 1999 年 7 月至 2003 年 6 月期间新诊断为 HIV 的患者队列的就诊记录。将 ED 就诊前一年内且无 ED 进行 HIV 检测建议或检测记录的情况定义为 HIV 诊断机会缺失。研究结果为错过机会的就诊次数和每个 ED 中错过机会的患者数量。我们还使用一份可能提示检测的广泛适应证清单，对错过机会的就诊记录进行了二次回顾。
在 276 名新诊断为 HIV 的患者中，有 123 名（44.5%）在诊断前一年曾就诊于 ED 或在 ED 中确诊。城市学术型 ED 的 HIV 检测项目诊断出 23 例（8.3%）病例，并向 24 名拒绝检测的患者提供了检测。76 名（27.5%）患者的 187 次就诊中出现了错过机会的情况。其中包括 70 名患者在城市学术型 ED 的 157 次就诊、9 名患者在城市社区 ED 的 24 次就诊和 4 名患者在郊区社区 ED 的 6 次就诊。在 187 次错过机会的就诊中，有 172 次可获取医疗记录。就诊时的潜在检测指征包括：HIV 危险因素（58 例，34%）、相关诊断提示风险（7 例，4%）、艾滋病定义性疾病（8 例，5%）、医生怀疑 HIV（29 例，17%）和非特异性的可能与 HIV 一致的疾病体征或症状（126 例，73%）。
地理位置相近的 ED 在早期 HIV 诊断机会方面存在差异，但 3 家 ED 均存在 HIV 诊断机会缺失的情况。许多未确诊 HIV 的 ED 患者的潜在检测指征都有记录，即使没有专门的风险评估，尽管其中大多数是非特异性的疾病体征或症状，可能不是有用的临床选择标准。
