Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED

Yu-Hsiang Hsieh, Jason S. Haukoos, Richard Rothman

Research output: Contribution to journalArticle

Abstract

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 15 184 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.

Original languageEnglish (US)
Pages (from-to)775-779
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume32
Issue number7
DOIs
StatePublished - 2014

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HIV Infections
Hospital Emergency Service
HIV
Confidence Intervals
Risk-Taking
Sexual Behavior
ROC Curve
Calibration
Cohort Studies
History
Demography
Interviews
Injections
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{49f757f1488c4a7fb9f227f30674a2f6,
title = "Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED",
abstract = "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 15 184 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.",
author = "Yu-Hsiang Hsieh and Haukoos, {Jason S.} and Richard Rothman",
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AU - Hsieh, Yu-Hsiang

AU - Haukoos, Jason S.

AU - Rothman, Richard

PY - 2014

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N2 - 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 15 184 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.

AB - 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 15 184 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.

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