Validation of an abbreviated version of the Denver HIV risk score for prediction of HIV infection in an urban ED.
OBJECTIVE
We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence.


METHODS
We performed a secondary analysis of data collected prospectively between November 2005 and December 2009 as part of an ED-based nontargeted rapid HIV testing program from 2 sites. Demographics; HIV testing history; injection drug use; and select high-risk sexual behaviors, including men who have sex with men, were collected by standardized interview. Information regarding receptive anal intercourse and vaginal intercourse was either not collected or collected inconsistently and was thus omitted from the model to create its abbreviated version.


RESULTS
The study cohort included 15184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was 0.41% (95% confidence interval [CI], 0.21%-0.71%) for those with a score less than 20, 0.29% (95% CI, 0.14%-0.52%) for those with a score of 20 to 29, 0.65% (95% CI, 0.48%-0.87%) for those with a score of 30 to 39, 2.38% (95% CI, 1.68%-3.28%) for those with a score of 40 to 49, and 4.57% (95% CI, 2.09%-8.67%) for those with a score of 50 or higher. External validation resulted in good discrimination (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.71-0.79). The calibration regression slope was 0.92 and its R(2) was 0.78.


CONCLUSIONS
An abbreviated version of the Denver HIV Risk Score had comparable performance to that reported previously, offering a promising alternative strategy for HIV screening in the ED where limited sexual risk behavior information may be obtainable.
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA. Electronic address: yhsieh1@jhmi.edu.
Yu-Hsiang
YH
Hsieh
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
Jason S
JS
Haukoos
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA.
Richard E
RE
Rothman
D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D016014:Linear Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult