Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.
The University of New South Wales, Sydney, New South Wales, Australia.
Liver Int. 2023 Jan;43(1):60-68. doi: 10.1111/liv.15414. Epub 2022 Sep 14.
Significant barriers exist with hepatitis B (HBV) case detection and effective linkage to care (LTC). The emergency department (ED) is a unique healthcare interaction where hepatitis screening and LTC could be achieved. We examined the efficacy and utility of automated ED HBV screening for Overseas Born (OB) patients.
A novel-automated hepatitis screening service "SEARCH" (Screening Emergency Admissions at Risk of Chronic Hepatitis) was piloted at a metropolitan hospital. A retrospective and comparative analysis of hepatitis testing during the SEARCH pilot compared to a period of routine testing was conducted.
During the SEARCH pilot, 4778 OB patients were tested for HBV (86% of eligible patient presentations), compared with 1.9% of eligible patients during a control period of clinician-initiated testing. SEARCH detected 108 (2.3%) hepatitis B surface antigen positive patients including 20 (19%) in whom the diagnosis was new. Among 88 patients with known HBV, 57% were receiving medical care, 33% had become lost to follow-up and 10% had never received HBV care. Overall, 30/88 (34%) patients with known HBV were receiving complete guideline-based care prior to re-engagement via SEARCH. Following SEARCH, LTC was successful achieved in 48/58 (83%) unlinked patients and 19 patients were commenced on anti-viral therapy. New diagnoses of cirrhosis and hepatocellular carcinoma were made in five and one patient(s) respectively.
Automated ED screening of OB patients is effective in HBV diagnosis, re-diagnosis and LTC. Prior to SEARCH, the majority of patients were not receiving guideline-based care.
乙型肝炎（HBV）病例检测和有效衔接护理（LTC）存在重大障碍。急诊科（ED）是一个独特的医疗保健互动场所，可在此进行肝炎筛查和 LTC。我们研究了自动 ED HBV 筛查对海外出生（OB）患者的疗效和实用性。
在一家大都市医院试点了一种新型自动化肝炎筛查服务“SEARCH”（筛查慢性肝炎风险的急诊入院）。对 SEARCH 试点期间的肝炎检测与常规检测期间进行了回顾性和对比分析。
在 SEARCH 试点期间，4778 名 OB 患者接受了 HBV 检测（占合格患者就诊的 86%），而在常规检测期间，只有 1.9%的合格患者接受了检测。SEARCH 发现了 108 例乙型肝炎表面抗原阳性患者，其中 20 例（19%）为新诊断。在 88 例已知 HBV 的患者中，57%正在接受医疗护理，33%已失访，10%从未接受过 HBV 护理。总体而言，在通过 SEARCH 重新联系之前，30/88（34%）例已知 HBV 的患者接受了基于指南的完整护理。通过 SEARCH 后，成功实现了 48/58（83%）例未链接患者的 LTC，并且有 19 例患者开始接受抗病毒治疗。分别在 5 例和 1 例患者中发现了新的肝硬化和肝细胞癌诊断。
对 OB 患者进行自动 ED 筛查可有效诊断、重新诊断和治疗 HBV 并进行 LTC。在 SEARCH 之前，大多数患者未接受基于指南的护理。
