title: Opportunities for earlier HIV diagnosis in a pediatric ED.
abstract: OBJECTIVE
  Emergency department (ED) HIV screening is recommended but challenging to implement and of uncertain effectiveness in pediatric EDs (PEDs). We sought to determine whether there were opportunities for earlier HIV diagnosis in the PED for a cohort of young adults diagnosed with HIV.
  
  
  METHODS
  This retrospective cohort study reviewed PED records of a group of young adults receiving HIV care in an urban hospital setting. Pediatric ED visits were selected for review if they took place after the patient's estimated time of HIV acquisition and before their eventual diagnosis. Charts were reviewed to determine whether HIV infection was suspected and whether testing was offered.
  
  
  RESULTS
  Among a cohort of HIV-positive young adults, only 3 (3.6%; 95% confidence interval, 0.9-10.8) of 84 were seen in the PED during the time they were undiagnosed but likely to be infected with HIV. Among these subjects, there was no documentation that HIV testing was offered or refused nor was there documented suspicion of HIV.
  
  
  CONCLUSIONS
  There are opportunities for earlier diagnosis of HIV in PEDs, affirming the importance of HIV screening implementation in these settings. However, PEDs are unlikely to have the same frequency of contact with undiagnosed individuals as do adult EDs. Alternative methods of accessing at-risk adolescent populations must be identified.
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Eckerle
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Madjimbaye
authors.initials: M
authors.lastname: Namde
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Holland
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Ruffner
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Kim W
authors.initials: KW
authors.lastname: Hart
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Reed
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: lyonsme@ucmail.uc.edu.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult