Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA.
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
Am J Emerg Med. 2014 Jul;32(7):775-9. doi: 10.1016/j.ajem.2014.02.043. Epub 2014 Mar 5.
We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence.
We performed a secondary analysis of data collected prospectively between November 2005 and December 2009 as part of an ED-based nontargeted rapid HIV testing program from 2 sites. Demographics; HIV testing history; injection drug use; and select high-risk sexual behaviors, including men who have sex with men, were collected by standardized interview. Information regarding receptive anal intercourse and vaginal intercourse was either not collected or collected inconsistently and was thus omitted from the model to create its abbreviated version.
The study cohort included 15184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was 0.41% (95% confidence interval [CI], 0.21%-0.71%) for those with a score less than 20, 0.29% (95% CI, 0.14%-0.52%) for those with a score of 20 to 29, 0.65% (95% CI, 0.48%-0.87%) for those with a score of 30 to 39, 2.38% (95% CI, 1.68%-3.28%) for those with a score of 40 to 49, and 4.57% (95% CI, 2.09%-8.67%) for those with a score of 50 or higher. External validation resulted in good discrimination (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.71-0.79). The calibration regression slope was 0.92 and its R(2) was 0.78.
An abbreviated version of the Denver HIV Risk Score had comparable performance to that reported previously, offering a promising alternative strategy for HIV screening in the ED where limited sexual risk behavior information may be obtainable.
我们旨在评估简化版丹佛艾滋病毒风险评分在两家已知艾滋病毒未确诊率较高的城市急诊部门（ED）中的表现。
我们对 2005 年 11 月至 2009 年 12 月期间作为基于 ED 的非目标快速艾滋病毒检测计划的一部分前瞻性收集的数据进行了二次分析。通过标准化访谈收集人口统计学数据；艾滋病毒检测史；注射毒品使用；以及包括男男性行为者在内的某些高危性行为。关于接受肛交和阴道交的信息要么没有收集，要么收集不一致，因此从模型中省略以创建其简化版。
研究队列包括 15184 名患者，其中 114 名（0.75%）新诊断为 HIV 感染。得分低于 20 分的患者 HIV 患病率为 0.41%（95%置信区间[CI]，0.21%-0.71%），得分在 20 到 29 分的患者为 0.29%（95%CI，0.14%-0.52%），得分在 30 到 39 分的患者为 0.65%（95%CI，0.48%-0.87%），得分在 40 到 49 分的患者为 2.38%（95%CI，1.68%-3.28%），得分在 50 分或以上的患者为 4.57%（95%CI，2.09%-8.67%）。外部验证导致了良好的区分度（接受者操作特征曲线下面积，0.75；95%CI，0.71-0.79）。校准回归斜率为 0.92，其 R²为 0.78。
简化版丹佛艾滋病毒风险评分的表现与之前报道的相当，为 ED 中的艾滋病毒筛查提供了一种有前途的替代策略，因为在 ED 中可能获得有限的性风险行为信息。
