Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations.
Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations.
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DOI：
10.1097/olq.0000000000001311
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发表时间：
2021-05-01
影响因子：
3.1
通讯作者：
Schneider J
中科院分区：
文献类型：
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作者：
Stanford KA;Hazra A;Friedman E;Devlin S;Winkler N;Ridgway JP;Schneider J
在美国，随着梅毒发病率的迅速上升，需要有新的方法对高危人群进行筛查和治疗。2019年5月，在一家大型城市三级医院急诊科实施了一项常规选择退出梅毒筛查计划，以急诊科艾滋病毒筛查的成功模式为基础。本研究旨在评估梅毒在这一人群中的患病率，并评估常规、选择性退出梅毒筛查模式。对2019年6月至12月在急诊科接受梅毒筛查的所有患者进行回顾性图表回顾。调查了人口统计信息、艾滋病毒状况、主诉和随访。在研究期间，9198名年龄在18到64岁之间的人接受了梅毒筛查。其中推定感染活动性梅毒97例（1.1%），推定未感染活动性梅毒354例（3.8%），阴性8747例（95.1%）。PAI更有可能是男性（67%,aOR 3.5, 95% CI (2.3, 5.3), p<0.001），尽管女性的比例明显高于全国报告的比例，而且大多数是非西班牙裔黑人（93.8%）。PAI中HIV阳性23例（23.7%）。只有18.6%的PAI出现与性传播感染（STIs）有关的投诉。该社区的梅毒发病率非常高，许多感染发生在按人口统计学传统上被认为风险较低或有主诉的人群中，这表明需要进行普遍筛查。在高流行社区进行常规ED梅毒筛查对于解决梅毒流行问题至关重要。一项对城市急诊科普遍进行梅毒筛查的研究发现，梅毒的发病率很高（占筛查人群的1.1%）。大多数感染发生在以非性传播感染为主诉的患者中。
With syphilis rates rising rapidly in the United States, novel means of reaching high-risk populations for screening and treatment are needed. Building on successful models for emergency department (ED) HIV screening, a routine opt-out syphilis screening program was implemented in a large, urban, tertiary care hospital ED in May 2019. This study aims to assess the prevalence of syphilis in this population and to evaluate the routine, opt-out syphilis screening model. A retrospective chart review was performed of all patients screened for syphilis in the ED from June through December 2019. Demographic information, HIV status, chief complaint, and follow up visits were examined. During the study period, 9198 people ages 18 to 64 were screened for syphilis. Of these, 97 (1.1%) had presumed active syphilis infection (PAI), 354 (3.8%) were presumed not to have active syphilis, and 8747 (95.1%) were negative for infection. PAI were more likely to be male (67%, aOR 3.5, 95% CI (2.3, 5.3), p<0.001), though the percentage of women was considerably higher than the nationally-reported rate, and the majority were non-Hispanic black (93.8%). Among PAI, 23 (23.7%) were HIV positive. Only 18.6% of PAI presented with complaints related to sexually transmitted infections (STIs). Syphilis rates in this community are very high, and many infections were found in populations traditionally considered lower risk by demographic or presenting complaint, indicating that universal screening is needed. Routine ED syphilis screening in high-prevalence communities will be critical to addressing the syphilis epidemic. A study of universal syphilis screening in an urban emergency department found high rates of syphilis (1.1% of population screened). Most infections were found in patients presenting for non-STI complaints.