Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA 94602, USA.
Ann Emerg Med. 2011 Jul;58(1 Suppl 1):S53-9. doi: 10.1016/j.annemergmed.2011.03.025.
We compare the outcomes of 2 models of physician-initiated rapid HIV testing in an emergency department (ED).
One-year retrospective cohort comparing 2 6-month models of physician-initiated rapid HIV testing, point-of-care versus laboratory. Patients aged 12 years or older and able to give verbal consent were eligible for physician-initiated rapid HIV testing if their treating physician believed testing was clinically indicated. During the point-of-care phase, nursing staff performed oral fluid testing. During the laboratory phase, the laboratory performed whole-blood testing. The proportion of potentially eligible patients who had physician-initiated rapid HIV testing ordered (order rate), proportion of ordered tests completed (test completion rate), and proportion of potentially eligible patients who completed testing (overall testing rate) during each phase were assessed. ED length of stay and testing times were also compared.
For the point-of-care versus laboratory phase, respectively, there were 24,345 potentially eligible patients versus 26,363; order rate was 3.3% versus 2.4% (P<.001); test completion rate was 75.3% versus 86.8% (P<.001); overall testing rate was 2.5% versus 2.1% (P=.009). Eighteen (3.0%) of the point-of-care-tested patients and 15 (2.7%) of the laboratory-tested patients had reactive tests (P=0.02). The total testing time was greater in the laboratory phase (88 versus 66 minutes; P<.001); however, there was no significant difference in the length of stay between phases (6.2 versus 6.9 hours; P=.15).
Relatively few ED patients undergo physician-initiated rapid HIV testing regardless of whether a point-of-care or laboratory approach is used. Differences exist in most outcome measures when point-of-care and laboratory models are compared, which should be considered when testing is implemented.
我们比较了急诊科（ED）中两种医生主导的快速 HIV 检测模式的结果。
这是一项为期一年的回顾性队列研究，比较了两种为期 6 个月的医生主导的快速 HIV 检测模式，即即时检测和实验室检测。如果治疗医生认为检测具有临床指征，年龄在 12 岁及以上且能够口头同意的患者有资格接受医生主导的快速 HIV 检测。在即时检测阶段，护理人员进行口腔液检测。在实验室检测阶段，实验室进行全血检测。评估每个阶段潜在合格患者中接受医生主导的快速 HIV 检测的比例（检测订单率）、完成检测的比例（检测完成率）以及完成检测的潜在合格患者比例（总体检测率）。还比较了 ED 住院时间和检测时间。
在即时检测与实验室检测阶段，分别有 24345 名和 26363 名潜在合格患者；检测订单率分别为 3.3%和 2.4%（P<.001）；检测完成率分别为 75.3%和 86.8%（P<.001）；总体检测率分别为 2.5%和 2.1%（P=.009）。在即时检测组中，有 18 名（3.0%）患者的检测结果呈阳性，在实验室检测组中，有 15 名（2.7%）患者的检测结果呈阳性（P=0.02）。实验室检测阶段的总检测时间更长（88 分钟比 66 分钟；P<.001）；然而，两个阶段的住院时间没有显著差异（6.2 小时比 6.9 小时；P=.15）。
无论使用即时检测还是实验室检测方法，相对较少的 ED 患者接受医生主导的快速 HIV 检测。当比较即时检测和实验室模型时，大多数结果测量指标存在差异，在实施检测时应予以考虑。
