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National estimation of rates of HIV serology testing in US emergency departments 19932005: baseline prior to the 2006 Centers for Disease Control and Prevention recommendations

Hsieh, Yu-Hsianga; Rothman, Richard Ea,b; Newman-Toker, David Ec,d; Kelen, Gabor Da

doi: 10.1097/QAD.0b013e328310e066
Clinical Science

Objective: The 2006 Centers for Disease Control and Prevention recommendations place increased emphasis on emergency departments (EDs) as one of the most important medical care settings for implementing routine HIV testing. No longitudinal estimates exist regarding national rates of HIV testing in EDs. We analyzed a nationally representative ED database to assess HIV testing rates and characterize patients who received HIV testing, prior to the release of the 2006 guidelines.

Design: A cross-sectional analysis of US ED visits (1993–2005) using the National Hospital Ambulatory Medical Care Survey was performed.

Methods: Patients aged 13–64 years were included for analysis. Diagnoses were grouped with Healthcare Cost and Utilization Project Clinical Classifications Software. Analyses were performed using procedures for multiple-stage survey data.

Results: HIV testing was performed in an estimated 2.8 million ED visits (95% confidence interval, 2.4–3.2) or a rate of 3.2 per 1000 ED visits (95% confidence interval, 2.8–3.7). Patients aged 20–39 years, African–American, and Hispanic had the highest testing rates. Among those tested, leading reasons for visit were abdominal pain (9%), puncture wound/needlestick (8%), rape victim (6%), and fever (5%). The leading medication class prescribed was antimicrobials (32%). The leading ED diagnosis was injury/poisoning (30%) followed by infectious diseases (18%). Of note, 6% of those tested were diagnosed with HIV infection during their ED visits.

Conclusion: Prior to the release of the 2006 Centers for Disease Control and Prevention guidelines for routine HIV testing in all healthcare settings, baseline national HIV testing rates in EDs were extremely low and appeared to be driven by clinical presentation.

aDepartment of Emergency Medicine, USA

bDivision of Infectious Diseases, USA

cDepartment of Neurology, Johns Hopkins University School of Medicine, USA

dDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

Received 2 May, 2008

Revised 27 June, 2008

Accepted 4 July, 2008

Correspondence to Dr Yu-Hsiang Hsieh, Johns Hopkins University Department of Emergency Medicine, 5801 Smith Avenue, Suite 3220, Davis Building, Baltimore, MD 21209, USA. Tel: +1 410 735 6413; fax: +1 410 735 6425; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.