在急诊室进行查:DETECT 型肝炎随机临床试验
Jason Haukoos1,2,3,4, Richard E Rothman5, James W Galbraith6
1Department of Emergency Medicine, Denver Health, Denver, Colorado.
JAMA
|July 9, 2025
概括
在急诊室的非向性查发现的新感染人数多于向性查. 然而,与护理和治疗完成的联系仍然是两种方法的重大挑战.
科学领域:
- 公共卫生
- 传染性疾病
- 肝病学
背景情况:
- 鉴定型肝炎病毒 (HCV) 感染是公共卫生的优先事项.
- 紧急诊所 (ED) 是对可能缺乏持续医疗服务的风险人口进行查的关键设置.
- 在ED中尚未建立最佳的HCV查策略.
研究的目的:
- 在急诊室比较非向性和向性HCV查的有效性.
- 测试非向查比向查产生更多新的HCV诊断的假设.
主要方法:
- 一个前性的多中心实用随机临床试验, 涉及3个城市急救中心的147,498名患者.
- 18岁以上的患者被随机分为非向性 (普遍) 或向性 (基于风险) HCV查.
- 主要结局是新诊断的HCV感染 (检测到RNA);次要结局包括与护理和治疗里程碑的联系.
主要成果:
- 与目标查 (115) 相比,非目标查发现了显著更多的新型HCV感染 (RR,1.34;P=.02).
- 针对性的查率为6. 3%,非针对性的查率为13. 4%.
- 在这两组中,与治疗的关联,治疗开始,治疗结束和持续的病毒反应 (SVR12) 率都很低.
结论:
- 不针对性HCV查是城市ED环境中检测病例的优越策略.
- 从诊断到持续的病毒反应,在HCV治疗连续性中存在显著的差距.
- 迫切需要创新的模式来改善HCV治疗的参与度和结果.
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