Preventive care in the emergency department: should emergency departments conduct routine HIV screening? a systematic review. Export

@article{citeulike:350073, abstract = {OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of offering routine HIV screening to patients in the emergency department (ED). METHODS: The systematic review was conducted with the aid of a structured template, a companion explanatory guide, and a grading and methodological scoring system based on published criteria for critical appraisal. Two reviewers conducted independent searches using OvidR, PubMed, MD Consult, and Grateful Med. Relevant abstracts were reviewed; those most pertinent to the stated objective were selected for complete evaluation using the structured template. RESULTS: Fifty-two relevant abstracts were reviewed; of these, nine were selected for detailed evaluation. Seven ED-based prospective cross-sectional seroprevalence studies found HIV rates of 2-17\%. Highest rates of infection were seen among patients with behavioral risks such as male homosexual activity and intravenous drug use. Two studies demonstrated feasibility of both standard and rapid HIV testing in the ED, with more than half of the patients approached consenting to testing by either method, consistent with voluntary testing acceptance rates described in other settings. Several cost-benefit analyses lend indirect support for HIV screening in the ED. CONCLUSIONS: Multiple ED-based studies meeting the Centers for Disease Control and Prevention Guideline threshold to recommend routine screening, in conjunction with limited feasibility trials and extrapolation from cost-benefit studies, provide evidence to recommend that EDs offer HIV screening to high-risk patients (i.e., those with identifiable risk factors) or high-risk populations (i.e., those where HIV seroprevelance is at least 1\%).}, address = {Johns Hopkins University, Department of Emergency Medicine (RER, KSK, GDK), Baltimore, MD 21205, USA. rrothman@jhmi.edu}, author = {Rothman, R. E. and Ketlogetswe, K. S. and Dolan, T. and Wyer, P. C. and Kelen, G. D.}, citeulike-article-id = {350073}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/12615596}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=12615596}, issn = {1069-6563}, journal = {Acad Emerg Med}, keywords = {ed, emergencydepartment, hiv}, month = {March}, number = {3}, pages = {278--285}, posted-at = {2005-10-13 23:48:48}, priority = {2}, title = {Preventive care in the emergency department: should emergency departments conduct routine HIV screening? a systematic review.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/12615596}, volume = {10}, year = {2003} }

TY - JOUR ID - citeulike:350073 L3 - citeulike-article-id:350073 N2 - OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of offering routine HIV screening to patients in the emergency department (ED). METHODS: The systematic review was conducted with the aid of a structured template, a companion explanatory guide, and a grading and methodological scoring system based on published criteria for critical appraisal. Two reviewers conducted independent searches using OvidR, PubMed, MD Consult, and Grateful Med. Relevant abstracts were reviewed; those most pertinent to the stated objective were selected for complete evaluation using the structured template. RESULTS: Fifty-two relevant abstracts were reviewed; of these, nine were selected for detailed evaluation. Seven ED-based prospective cross-sectional seroprevalence studies found HIV rates of 2-17%. Highest rates of infection were seen among patients with behavioral risks such as male homosexual activity and intravenous drug use. Two studies demonstrated feasibility of both standard and rapid HIV testing in the ED, with more than half of the patients approached consenting to testing by either method, consistent with voluntary testing acceptance rates described in other settings. Several cost-benefit analyses lend indirect support for HIV screening in the ED. CONCLUSIONS: Multiple ED-based studies meeting the Centers for Disease Control and Prevention Guideline threshold to recommend routine screening, in conjunction with limited feasibility trials and extrapolation from cost-benefit studies, provide evidence to recommend that EDs offer HIV screening to high-risk patients (i.e., those with identifiable risk factors) or high-risk populations (i.e., those where HIV seroprevelance is at least 1%). IS - 3 JF - Acad Emerg Med SN - 1069-6563 AD - Johns Hopkins University, Department of Emergency Medicine (RER, KSK, GDK), Baltimore, MD 21205, USA. rrothman@jhmi.edu EP - 285 TI - Preventive care in the emergency department: should emergency departments conduct routine HIV screening? a systematic review. VL - 10 SP - 278 KW - ed KW - emergencydepartment KW - hiv AU - Rothman, RE AU - Ketlogetswe, KS AU - Dolan, T AU - Wyer, PC AU - Kelen, GD PY - 2003/03// UR - http://view.ncbi.nlm.nih.gov/pubmed/12615596 ER -