Zucker Jason, Cennimo David, Sugalski Gregory, Swaminathan Shobha
1 Division of Infectious Diseases, Departments of Internal Medicine and Pediatrics, Columbia University Medical Center , New York, New York.
2 Departments of Internal Medicine and Pediatrics, Rutgers-New Jersey Medical School , Newark, New Jersey.
AIDS Patient Care STDS. 2016 Jun;30(6):247-53. doi: 10.1089/apc.2016.0068.
Since 1993, the Centers for Disease Control recommendations for HIV testing were extended to include persons obtaining care in the emergency department (ED). Situated in Newark, New Jersey, the University Hospital (UH) ED serves a community with a greater than 2% HIV prevalence, and a recent study showed a UH ED HIV seroprevalence of 6.5%, of which 33% were unknown diagnoses. Electronic records for patients seen in the UH ED from October 1st, 2014, to February 28th, 2015, were obtained. Information was collected on demographics, ED diagnosis, triage time, and HIV testing. Random sampling of 500 patients was performed to identify those eligible for screening. Univariate and multivariate analysis was done to assess screening characteristics. Only 9% (8.8-9.3%) of patients eligible for screening were screened in the ED. Sixteen percent (15.7-16.6%) of those in the age group18-25 and 12% (11.6-12.3%) of those in the age group 26-35 were screened, whereas 8% (7.8-8.2%) of those in the age group 35-45 were screened. 19.6% (19-20.1%) of eligible patients in fast track were screened versus 1.7% (1.6-1.8%) in the main ED. Eighty-five percent of patients screened were triaged between 6 a.m. and 8 p.m. with 90% of all screening tests done by the HIV counseling, testing, and referral services. Due to the high prevalence of HIV, urban EDs play an integral public health role in the early identification and linkage to care of patients with HIV. By evaluating our current screening process, we identified opportunities to improve our screening process and reduce missed opportunities for diagnosis.
自1993年以来，美国疾病控制中心关于HIV检测的建议范围扩大至包括在急诊科（ED）接受治疗的人员。位于新泽西州纽瓦克市的大学医院（UH）急诊科所服务的社区，HIV流行率超过2%，并且最近一项研究显示，该大学医院急诊科的HIV血清阳性率为6.5%，其中33%为未确诊病例。获取了2014年10月1日至2015年2月28日期间在该大学医院急诊科就诊患者的电子记录。收集了人口统计学信息、急诊科诊断、分诊时间和HIV检测情况。对500名患者进行随机抽样，以确定符合筛查条件的患者。进行单因素和多因素分析以评估筛查特征。在急诊科，符合筛查条件的患者中只有9%（8.8 - 9.3%）接受了筛查。18 - 25岁年龄组中有16%（15.7 - 16.6%）的患者接受了筛查，26 - 35岁年龄组中有12%（11.6 - 12.3%）的患者接受了筛查，而35 - 45岁年龄组中有8%（7.8 - 8.2%）的患者接受了筛查。快速通道中19.6%（19 - 20.1%）符合条件的患者接受了筛查，而在主要急诊科中这一比例为1.7%（1.6 - 1.8%）。接受筛查的患者中有85%在上午6点至晚上8点之间进行了分诊，所有筛查检测中有90%是由HIV咨询、检测和转诊服务完成的。由于HIV的高流行率，城市急诊科在HIV患者的早期识别及与治疗的衔接方面发挥着不可或缺的公共卫生作用。通过评估我们目前的筛查流程，我们发现了改进筛查流程和减少诊断错失机会的机会。
