Maharaj R, Jeena L, Hahn E, Black J, Reynolds S J, Redd A D, Quinn T C, Hansoti B
Department of Emergency Medicine, Livingstone Hospital, Gqeberha, South Africa.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Afr J Emerg Med. 2022 Dec;12(4):498-504. doi: 10.1016/j.afjem.2022.08.003. Epub 2022 Oct 15.
Over a quarter of patients presenting to South African Emergency Centres (EC) have concurrent human immunodeficiency virus (HIV), yet it is unclear how this impacts their presenting complaints, the severity of illness, and overall resource needs in the EC. The primary objective of this study was to compare the performance of the South African Triage Score (SATS) in people living with HIV (PLWH) compared to HIV-negative patients. Secondary objectives included comparing the presentation characteristics and resource utilisation of these populations.
A prospective cross-sectional observational study was conducted in the Livingstone Hospital EC, Gqeberha, South Africa, to compare triage designation and clinical outcomes in PLWH and HIV-negative patients. In this six-week study, all eligible patients received point-of-care HIV testing and extensive data abstraction, including SATS designation and EC clinical course. Descriptive statistical analysis was completed, and a log-binomial model was used to examine the association between HIV status and clinical outcomes using crude (unadjPR) and adjusted prevalence ratios (adjPR).
During the study period, 755 adult patients who consented to a POC HIV test were enrolled, of which 193 (25.6%) were HIV positive. HIV-positive patients were significantly more likely to be admitted compared to their HIV-negative counterparts when triaged as low acuity (adjPR 1.48, 95% CI 1.14-1.92, (p=0.003)). HIV-positive patients were also significantly more likely to receive laboratory testing when triaged as low acuity (adjPR 1.31, 95% CI 1.08-1.59 (p=0.006)) and as high acuity (adjPR 1.38, 95% CI 1.08-1.59 (p=0.034)) compared to HIV negative patients of the same triage categories.
In our study, PLWH, compared to HIV-negative patients in the same category, were more likely to be admitted and require more EC resources, thus alluding to possible under triage of HIV-positive patients under the current SATS algorithm.
前往南非急诊中心（EC）就诊的患者中，超过四分之一同时感染了人类免疫缺陷病毒（HIV），但尚不清楚这对他们的就诊主诉、疾病严重程度以及急诊中心的总体资源需求有何影响。本研究的主要目的是比较南非分诊评分（SATS）在HIV感染者（PLWH）与HIV阴性患者中的表现。次要目的包括比较这些人群的就诊特征和资源利用情况。
在南非伊丽莎白港的利文斯通医院急诊中心进行了一项前瞻性横断面观察研究，以比较PLWH和HIV阴性患者的分诊指定和临床结局。在这项为期六周的研究中，所有符合条件的患者均接受了即时HIV检测和广泛的数据提取，包括SATS指定和急诊中心临床病程。完成了描述性统计分析，并使用对数二项模型，通过粗患病率比（unadjPR）和调整患病率比（adjPR）来检验HIV状态与临床结局之间的关联。
在研究期间，755名同意进行即时HIV检测的成年患者入组，其中193人（25.6%）为HIV阳性。在分诊为低急症时，HIV阳性患者与HIV阴性患者相比，入院的可能性显著更高（adjPR 1.48，95% CI 1.14 - 1.92，(p = 0.003)）。与相同分诊类别的HIV阴性患者相比，HIV阳性患者在分诊为低急症时（adjPR 1.31，95% CI 1.08 - 1.59 (p = 0.006)）和高急症时（adjPR 1.38，95% CI 1.08 - 1.59 (p = 0.034)）接受实验室检测的可能性也显著更高。
在我们的研究中，与同一类别的HIV阴性患者相比，PLWH入院的可能性更高，并且需要更多的急诊中心资源，因此表明在当前的SATS算法下，HIV阳性患者可能未得到充分分诊。
