title: Emergency department utilization by HIV-positive adults in the HAART era.
abstract: BACKGROUND
  No published study has analyzed emergency department (ED) utilization by human immunodeficiency virus (HIV)-positive adults in the highly active antiretroviral therapy (HAART) era.
  
  
  OBJECTIVE
  The purpose of this study is to describe the demographic and HIV-specific variables associated with ED utilization by HIV-positive adults and their diagnoses when discharged from the ED or subsequently from the hospital.
  
  
  METHODS
  We conducted a retrospective cohort study of all HIV-positive adults cared for at a tertiary center HIV clinic and ED (1 January-31 December 2006). Demographic, HIV clinical, and HIV lab variables were abstracted from the clinic database. ED/hospital diagnoses coded by the ICD-9 Diseases/Injuries Tabular Index were abstracted from identified discharge records. We used multivariate logistic regression to compute odds ratios (OR) of ED utilization based on the abstracted variables. We described the cohort and diagnoses using descriptive statistics.
  
  
  RESULTS
  A total of 356 patients met inclusion criteria. Their mean age was 42.7 years, and 77.2% of included patients were male; 52.5% were Caucasian and 47.5% non-Caucasian; 72 patients (20.2%) presented to the ED during the study period [153 visits; 37 (10.4%) required hospitalization (61/153 visits)]. Income level and mean 2006 viral load had a significant association (p < 0.05) with ED utilization. Of 155 ICD-9 ED discharge diagnoses, ill-defined symptoms/signs (25.2%), injury (18.7%), and musculoskeletal disorders (11.6%) were most prevalent. Of 450 ICD-9 hospital discharge diagnoses, endocrine/metabolic (13.3%), psychiatric (12.2%), infectious/parasitic (12%), and circulatory disorders (11.8%) were most prevalent.
  
  
  CONCLUSIONS
  In this study of HIV-positive adults, income level and mean 2006 viral load had a significant association with ED utilization. Noninfectious diagnoses were alone most prevalent in ED discharged, but not hospitalized, patients.
authors.affiliation: Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA. avenkat@wpahs.org
authors.forename: Arvind
authors.initials: A
authors.lastname: Venkat
authors.forename: Brian
authors.initials: B
authors.lastname: Shippert
authors.forename: Douglas
authors.initials: D
authors.lastname: Hanneman
authors.forename: Chadd
authors.initials: C
authors.lastname: Nesbit
authors.forename: David M
authors.initials: DM
authors.lastname: Piontkowsky
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhat
authors.forename: Morgen
authors.initials: M
authors.lastname: Kelly