Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department
Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department
复制标题
DOI：
10.1093/cid/ciw074
复制
发表时间：
2016-05-01
影响因子：
11.8
通讯作者：
Quinn, Thomas C.
中科院分区：
文献类型：
--
作者：
Hsieh, Yu-Hsiang;Rothman, Richard E.;Quinn, Thomas C.
背景。除了基于风险的针对性检测之外，美国疾病控制与预防中心 (CDC) 建议对 1945-1965 出生队列进行 1 次丙型肝炎病毒 (HCV) 检测。急诊科 (ED) 是 HCV 检测的主要场所，因为其服务的人口众多且 HIV 筛查取得了成功。我们确定了急诊室中未记录的 HCV 感染负担，为实施基于急诊室的 HCV 检测提供了指导。方法。 2013 年，在城市急诊室进行了一项为期 8 周的血清阳性率研究。所有因临床目的而采集过量血液的患者均被纳入其中。从电子病历中获得人口统计和临床信息，包括记录的丙型肝炎病毒感染。对过量样本进行 HCV 抗体检测。结果。在 4713 名患者中，652 名（13.8%）HCV 抗体呈阳性。其中，204 人（31.3%）患有未记录的 HCV 感染。在无记录感染的患者中，99 例（48.5%）是通过出生队列检测确诊的，另外 54 例（26.5%）是通过基于风险的检测确诊的。如果我们的急诊室遵守 CDC 指南，那么 51 名 (25.0%) 患有无证 HCV 的患者就不会接受检测。鉴于估计 1 年内有 7727 名独特的 ED 患者感染 HCV，出生队列加上基于风险的检测将识别出 1815 名未记录的感染者，而普遍检测将识别出另外 526 名 HCV 感染者。结论。相对于仅基于风险的检测，基于出生队列的检测将使急诊室中未记录的 HCV 感染的识别增加两倍。然而，我们的数据表明，如果采用当前的 CDC 出生队列建议，四分之一的感染将仍未得到诊断，这表明在高风险城市 ED 环境中，普遍进行一次性检测的做法可能更有效。
Background. The Centers for Disease Control and Prevention (CDC) recommends 1-time hepatitis C virus (HCV) testing in the 1945-1965 birth cohort, in addition to targeted risk-based testing. Emergency departments (EDs) are key venues for HCV testing because of the population served and success in HIV screening. We determined the burden of undocumented HCV infection in our ED, providing guidance for implementation of ED-based HCV testing.Methods. An 8-week seroprevalence study was conducted in an urban ED in 2013. All patients with excess blood collected for clinical purposes were included. Demographic and clinical information including documented HCV infection was obtained from electronic medical records. HCV antibody testing was performed on excess samples.Results. Of 4713 patients, 652 (13.8%) were HCV antibody positive. Of these, 204 (31.3%) had undocumented HCV infection. Among patients with undocumented infections, 99 (48.5%) would have been diagnosed based on birth cohort testing, and an additional 54 (26.5%) would be identified by risk-based testing. If our ED adhered to the CDC guidelines, 51 (25.0%) patients with undocumented HCV would not have been tested. Given an estimated 7727 unique ED patients with HCV infection in a 1-year period, birth cohort plus risk-based testing would identify 1815 undocumented infections, and universal testing would identify additional 526 HCV-infected persons.Conclusions. Birth cohort-based testing would augment identification of undocumented HCV infections in this ED 2-fold, relative to risk-based testing only. However, our data demonstrate that one-quarter of infections would remain undiagnosed if current CDC birth cohort recommendations were employed, suggesting that in high-risk urban ED settings a practice of universal 1-time testing might be more effective.