Salmerón-Béliz Octavio José, Pérez-Fernández Elia, Miró Oscar, Salido-Mota Manuel, Diez-Diez Verónica, Gil-Mosquera Manuel, Robert-Boter Neus, Arranz-Betegón María, Navarro-Bustos Carmen, Guardiola-Tey José María, González-Del-Castillo Juan
Unidad de Urgencias, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2023 Aug-Sep;41(7):407-413. doi: 10.1016/j.eimce.2021.12.010. Epub 2022 Jun 2.
There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED.
Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis.
Seven hundred twenty-three patients were included, and 352 (48.7%, 95%CI: 45.1%-52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2, p25-p75: 1-4). One hundred and eighteen patients (16.3%, 95%CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use [145 (15%)], sexually transmitted infections [91 (9.4%)] and request for post-exposure HIV prophylaxis [39 (4%)]. One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days.
Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.
HIV感染存在隐匿性感染率高和诊断延迟的情况。医院急诊科是医疗保健的重要环节。本研究旨在了解急诊科发生的HIV诊断错失机会的数量。
回顾性多中心队列研究，纳入了2019年在7个不同自治区的27家西班牙医院诊断为HIV感染的所有患者。对诊断前5年的所有急诊科会诊记录进行审查，以查明会诊原因以及这是否代表HIV诊断的错失机会。
共纳入723例患者，其中352例（48.7%，95%CI：45.1%-52.3%）在诊断前5年至少有一次急诊科就诊（中位数为2次，第25百分位数-第75百分位数：1-4次）。118例患者（16.3%，95%CI：13.8%-19.2%）存在诊断错失机会。主要会诊原因包括药物使用[145例（15%）]、性传播感染[91例（9.4%）]和暴露后HIV预防需求[39例（4%）]。在352例有过急诊科就诊的患者中，155例（42.9%）在确诊HIV时CD4细胞计数低于350/mm³。在曾就诊于急诊科的患者中，从此次就诊到诊断的平均时间为580（标准差647）天。
16%的HIV确诊患者在诊断前5年错失了诊断机会，这凸显了需要实施与当前不同的急诊科筛查措施以改善这些结果。
