Successful Screening and Referral for HIV, Hepatitis C in a Trauma Population

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Patients who had positive results for HCV and/or HIV were educated about their disease and referred to disease-specific follow-up visits.
Patients who had positive results for HCV and/or HIV were educated about their disease and referred to disease-specific follow-up visits.

A new routine screening protocol that is easily applied to trauma activations demonstrated that the rates of trauma patients screening positive for a new diagnosis of HIV and hepatitis C were almost 3 times the national average and allowed these patients to be referred to education and follow-up treatment, according to a study published in The Journal of Trauma and Acute Care Surgery.

Study investigators established an easily applied routine screening protocol at their American College of Surgeons verified Level 1 trauma center. HIV and hepatitis C tests were added to the standard order set used for all level trauma activations. Of the 1898 trauma patients between January 1, 2016 and June 30, 2017, 1217 were screened (64.1%). Patients who screened positive were further tested for confirmation, then were either admitted for treatment where they would receive an infectious disease consult or were referred to outpatient clinic treatment. All patients were given clinical information regarding their diagnosis. Out of the 1217 screened patients, 65 (5.5%) screened positive for a blood borne disease (4.4% hepatitis C and 1.1% HIV).

Clinical staff in the hospital informed and educated 100% of patients with a new diagnosis of HIV regarding their disease and 88.2% had a successful screening intervention either before or after discharge.  In patients who had a new or prior diagnosis of HIV, 100% had a referral placed or ongoing outpatient treatment verified prior to discharge.  In patients with Hepatitis C virus diagnosis, new or ongoing, 87.1% had referrals placed or verification of ongoing outpatient treatment.

Study investigators conclude, “we have demonstrated the successful implementation of a unique and highly effective trauma activation-based screening and referral protocol for the diagnosis of HIV and Hepatitis C. The value of this protocol is that it focuses on a high yield patient population that may not otherwise receive recommended disease-centered screening and bridges a significant gap in health care delivery. By developing collaborative relationships with emergency, trauma, and infectious disease staff, similar protocols could be established nationwide at various trauma centers.”

Reference

White B, Privette A, Ferguson PL, Norcross ED, Richey LE. A different form of injury prevention: Successful screening and referral for HIV and hepatitis C in a trauma population [published online May 30, 2018]. J Trauma Acute Care Surg. doi: 10.1097/TA.0000000000001991

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