Nontargeted Hepatitis C Screening in an Urban Emergency Department in New York City.

BACKGROUND: Previously the Centers for Disease Control and Prevention (CDC) recommended targeted hepatitis C virus (HCV) screening for adults born between 1945 and 1965 and individuals with HCV risk factors. In April 2020, the CDC updated their recommendations to now include all individuals 18 years of age and older in settings with HCV prevalence > 0.1%. Few emergency departments (EDs) currently employ this nontargeted screening approach. OBJECTIVES: We examined how a shift from targeted to nontargeted screening might affect HCV case identification. We hypothesized that nontargeted screening could improve HCV case identification in our ED. METHODS: Retrospective review of prospectively collected nontargeted screening data from June 6, 2018 to June 5, 2019 in a large urban academic ED. Patients 18 years of age and older, triaged to the adult or pediatric ED and able to provide consent for HCV testing, were eligible for study inclusion. RESULTS: There were 83,864 ED visits and 40,282 unique patients deemed eligible for HCV testing. Testing occurred in 10,630 (26.4%) patients, of which 638 (6%) had positive HCV antibody (Ab+) tests and 214 (2%) had a positive viral load (VL+). Birth cohort-targeted screening would have identified 48% of the patients with Ab+ tests and 47% of those who were VL+. Risk-based targeted screening would increase the number of Ab+ patients to 67% and VL+ to 72%. CONCLUSIONS: Nontargeted ED-based HCV screening can identify a large number of patients with HCV infection. A shift from targeted to nontargeted screening may result in fewer missed infections but requires further study.

Spanish and English video-assisted informed consent for intravenous contrast administration in the emergency department: a randomized controlled trial.

STUDY OBJECTIVE: This study determined whether Spanish and English educational videos are superior to routine discussion for informing emergency department (ED) patients about risks, benefits, and alternatives to receiving intravenous contrast for computed tomography (CT). METHODS: A prospective randomized controlled trial was performed on a convenience sample of adult ED patients scheduled to receive intravenous contrast for CT. Patients randomized to the intervention group watched a video in Spanish or English explaining the procedure and its risks, benefits, and alternatives. The control group underwent routine discussion, receiving intravenous contrast information from their emergency physician. After their educational sessions, all participants completed a 10-question intravenous contrast knowledge measure and 1 question rating satisfaction with the informed consent process. Mean scores were compared to assess whether the videos were superior to routine discussion for educating patients about intravenous contrast. Secondary outcomes included the proportion of satisfied patients and refusals to sign consent. RESULTS: Of the 112 patients enrolled, 56 were randomized to the video group and 56 to routine discussion. Five patients withdrew from the study, leaving 107 for analysis (video N=53; control N=54). Mean knowledge scores were higher in the video group (68.1%) compared to routine discussion (47.8%) (95% confidence interval [CI] for the difference 12.6% to 28.1%). Video-group patients exhibited greater satisfaction than routine-discussion patients (86.8% [95% CI 74.6% to 94.5%] versus 77.4% [95% CI 63.8% to 87.7%]). All patients signed consent to receive intravenous contrast. CONCLUSION: Using Spanish and English educational videos yielded higher intravenous contrast knowledge scores compared with routine informed consent procedures.