Comparison of Enhanced Targeted Rapid HIV Screening Using the Denver HIV Risk Score to Nontargeted Rapid HIV Screening in the Emergency Department
Comparison of Enhanced Targeted Rapid HIV Screening Using the Denver HIV Risk Score to Nontargeted Rapid HIV Screening in the Emergency Department
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DOI：
10.1016/j.annemergmed.2012.10.031
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发表时间：
2013-03-01
影响因子：
6.2
通讯作者：
Thrun, Mark W.
中科院分区：
文献类型：
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作者：
Haukoos, Jason S.;Hopkins, Emily;Thrun, Mark W.
研究目标：最近开发了一种临床预测工具——丹佛艾滋病毒风险评分，以帮助识别未确诊艾滋病毒感染可能性增加的患者。我们的目标是将使用丹佛 HIV 风险评分的针对性快速 HIV 筛查与城市急诊科 (ED) 和紧急护理中的非针对性快速 HIV 筛查进行比较。 方法：我们在城市医疗中心采用前瞻性前后设计，每年对 110,000 人次就诊进行普查。 13 岁或以上的患者有资格接受筛查。护士在医疗筛查期间使用丹佛艾滋病毒风险评分对确定为高风险的患者进行有针对性的艾滋病毒筛查，并将其与医疗筛查护士在 2 个独立的 4 个月时间段内提供的非针对性艾滋病毒筛查进行比较。主要结局是新诊断的 HIV 感染者。结果：目标阶段有 28,506 名患者就诊，其中 1,718 名患者被确定为高危患者，551 名患者完成了 HIV 检测。其中，7 人（1.3%，95% 置信区间 [Cl] 0.5% 至 2.6%）新诊断出 HIV 感染。 29,510 名患者在非靶向阶段就诊，3,591 名患者完成了 HIV 检测。其中，7 人（0.2%，95% Cl 0.1% 至 0.4%）新诊断出艾滋病毒感染者。与非针对性筛查相比，根据患者人口统计数据和付款人状况进行调整后，针对性 HIV 筛查与新诊断 HIV 感染的识别显着相关（相对风险 [RR] 10.4，95% Cl 3.4 至 32.0）。结论：与非针对性筛查相比，使用丹佛 HIV 风险评分的针对性 HIV 筛查与新诊断 HIV 感染密切相关。尽管两种艾滋病毒筛查方法发现新诊断患者的绝对数量相同，但在目标阶段实现相同效果所需的检测数量明显减少。 [安紧急医学。 2013；61：353-361。]
Study objective: A clinical prediction tool, the Denver HIV Risk Score, was recently developed to help identify patients with increased probability of undiagnosed HIV infection. Our goal was to compare targeted rapid HIV screening using the Denver HIV Risk Score to nontargeted rapid HIV screening in an urban emergency department (ED) and urgent care.Methods: We used a prospective, before-after design at an urban medical center with an approximate annual census of 110,000 visits. Patients aged 13 years or older were eligible for screening. Targeted HIV screening of patients identified as high-risk by nurses using the Denver HIV Risk Score during medical screening was compared to nontargeted HIV screening offered by medical screening nurses during 2 separate 4-month time periods. The primary outcome was newly diagnosed HIV-infected patients.Results: 28,506 patients presented during the targeted phase, 1,718 were identified as high-risk, and 551 completed HIV testing. Of these, 7 (1.3%, 95% confidence interval [Cl] 0.5% to 2.6%) were newly diagnosed with HIV infection. 29,510 patients presented during the nontargeted phase and 3,591 completed HIV testing. Of these, 7 (0.2%, 95% Cl 0.1% to 0.4%) were newly diagnosed with HIV infection. Targeted HIV screening was significantly associated with identification of newly diagnosed HIV infection when compared to nontargeted screening, adjusting for patient demographics and payer status (relative risk [RR] 10.4, 95% Cl 3.4 to 32.0).Conclusion: Targeted HIV screening using the Denver HIV Risk Score was strongly associated with new HIV diagnoses when compared to nontargeted screening. Although both HIV screening methods identified the same absolute number of newly diagnosed patients, significantly fewer tests were required during the targeted phase to achieve the same effect. [Ann Emerg Med. 2013;61:353-361.]