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DETECTING HEPATITIS INFECTION IN THE EMERGENCY DEPARTMENT
  1. LJ Hunter1,
  2. S Douthwaite2,3,
  3. G Nebbia2
  1. 1Emergency Department, Guy's & St Thomas' NHS Foundation Trust, London, UK
  2. 2Department of Infectious Diseases, Guy's & St Thomas' NHS Foundation Trust, London, UK
  3. 3Royal College of Physicians, London, UK

Abstract

Objectives & Background Hepatitis (HBV&HCV) testing in the UK is currently targeted at groups perceived to be at high risk. Late diagnosis is common. Initial infection may only be accompanied by a mild illness or be completely asymptomatic. Chronic infection can occur and may progress to liver fibrosis, cirrhosis, decompensated liver disease or hepatocellular carcinoma if untreated.1

Early diagnosis and treatment are effective in reducing disease progression (HBV) or elimination of the virus (HCV).

Our aim was to determine the potential for blood borne virus testing within the ED and to evaluate the burden of HBV/HCV in our local population.

Methods Patients over the age of 16 were offered Hepatitis B (Surface antigen) and Hepatitis C (IgG antibodies) testing, if they required venepuncture during their ED attendance, in a 6 week period from 15th February 2016–27th March 2016. Tests were ordered using a pre-configured order-set including a pre-selected Hep BsAg and HepC IgGAbs. Patients were informed of the intention to test all attendances and were able to opt out if desired. Positive test results were followed up at a rapid access one-stop clinic.

Results Over a 6 week period, 3073 (49%) and 2982 (47%) accepted testing for Hepatitis B and Hepatitis C respectively. 1.1% (n=35) tested positive for Hepatitis B surface antigen, indicating acute or chronic infection. 2.2% (n=66) tested positive for Hepatitis C antibodies, indicating current or previous HCV infection. Hepatitis C antigen testing was positive in 1.2% (n=35) indicating current HCV infection.

The median age of all patients tested was 45 years (16–100 years) female 51%.

HBV antibody positive: median age 42 years (24–82 years), Gender: Male 70% Ethnicity: 40% Black or Black British.

HCV antigen positive: Median age 41 years (22–77 years) Gender: Male 72%, 40% White British. Two newly diagnosed patients were eligible to be commenced on direct acting anti-virals. One patient had evidence of cirrhosis on initial fibroscan.

Conclusion Consider the ED for opportunistic blood borne virus testing in areas of high prevalence. We achieved testing rates of approximately 50% by use of a pre-configured blood order set and an opt-out policy, resulting in identification of new diagnoses and lost to follow-up patients. Use of a one-stop clinic provides rapid entry to care for positive patients and reduces burden of follow-up for the ED.

  • Trauma

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