ALTERNATIVE APPROACHES FOR EVALUATION OF FEVER IN IDUS

在美国有超过100万人 静脉注射吸毒者。这一流行病主要发生在 少数族裔的市中心人口，妇女几乎同样经常受到影响 作为男人 向注射吸毒者提供医疗服务造成了很大的压力， 在公共资源上，近50%的人口缺乏任何 健康保险的类型。 开发高效的诊断和 常见内科并发症的管理策略 在这组病人中， 人口。 感染性心内膜炎（infectious endocarditis，E）是目前世界上最严重的心内膜炎之一。 与IDU相关的并发症，具有显著的发病率和 在未被确认的病例中发生的死亡。 呈现临床特征 与IE相关的问题很难定义。 因为发现发烧 发生在近98%的注射吸毒者IE病例中，目前的做法是 将所有发热的注射吸毒者住院进行进一步的评估、测试和 观察. 虽然真正的发病率（约3，000 - 7，500） 注射吸毒者的IE相对较低，几乎是注射吸毒者的10倍。 诊断正在考虑每年住院。 这 这对医疗保健系统来说是一个巨大的经济负担。 到 迄今为止，还没有任何研究试图开发 在患者中的住院诊断的替代方法， 疾病正在考虑中。 本研究的目标是：（1）设计一个算法， 艾德期间可用的临床信息和诊断信息 评估以确定哪些发热性注射吸毒者最有可能患有IE，或 很可能出现需要住院治疗的并发症。 IDUs 发烧的病人将从艾德被安排到 来模拟艾德观察装置。 (2)确定潜在成本 与替代管理策略相关的节省（例如 门诊检测和随访，或基于艾德的快速评估） 注射吸毒者谁有上述任何一个低风险。 该试点的结果 调查将用于设计更大的前瞻性调查， 测试新的临床决策算法。 这项研究将提供第一个描述早期使用诊断 测试和临床评估相结合， 对大量发热注射吸毒者的评价。 执行 这种算法有可能为医疗保健系统节省数百 每年花费数百万美元在不必要的医疗费用上。

There are over 1 million persons in the United States who are intravenous drug users (IDUs). The epidemic has principally struck the minority inner-city population, with women affected nearly as frequently as men. Provision of medical services to IDUs places a significant strain on public resources, as close to 50 percent of this population lack any type of health insurance. Development of efficient diagnostic and management strategies for the common medical complications which occur in this group of patients have lagged behind that for other sectors of the population. Infective endocarditis (E) is one of the most serious medical complications associated with IDU, with significant morbidity and mortality occurring in unrecognized cases. Presenting clinical features associated with IE have been difficult to define. Because fever is found to occur in nearly 98 percent of cases of IE in IDUs, current practice is to hospitalize all febrile IDUs for further evaluation, testing and observation. Although the true incidence (approximately 3,000-7,500) of IE in IDUs is relatively low, nearly 10 times as many patients in whom the diagnosis is being considered are hospitalized each year. This represents a significant financial burden to the health care system. To date, there have been no studies which have attempted to develop alternative approaches to inpatient diagnosis in patients in whom the disease is being considered. The objectives of this study are: (1) To design an algorithm which uses clinical information and diagnostic adjuncts available during ED evaluation to identify which febrile IDUs are most likely to have IE, or are likely to develop complications that require hospitalization. IDUs with fever will be admitted from the ED to an in-patient unit arranged to simulate an ED observation unit. (2) To determine the potential costs savings associated with alternative management strategies (such as outpatient testing and follow-up, or ED based rapid evaluation) for those IDUs who have low risk for either of the above. Results from this pilot investigation will be used to design a larger prospective investigation to test the new clinical decision algorithm. The study will provide the first description of early use of diagnostic testing and clinical assessment applied in conjunction towards rapid evaluation of the large population of febrile IDUs. Implementation of this algorithm has the potential to save the health care system hundreds of millions of dollars each year in unnecessary hospital costs.