Background The prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation. Methods We implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January–November 2018) and the postimplementation period (January–November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time. Results Four-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001). Conclusions Our study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing. Data are available on reasonable request. Data will be made available on reasonable request. Please contact the study’s senior author, Dr Larissa May, for data inquiries.

中文翻译：

---

实施基于电子健康记录的警报前后的 ED 梅毒和淋病/衣原体联合检测实践


背景 在包括美国在内的许多国家，梅毒的患病率正在增加。急诊科通常由服务不足的人群使用，这使其成为测试和治疗未在门诊临床环境中进行评估的患者的重要场所。我们的目的是通过比较实施前后的测试实践来评估基于 ED 的梅毒和淋病/衣原体联合测试方案的实用性。方法 我们实施了电子健康记录 (EHR) 警报，提示临床医生对接受淋病/衣原体检测的患者进行梅毒检测。我们进行了回顾性队列分析，比较了实施前（2018 年 1 月至 11 月）和实施后（2019 年 1 月至 11 月）的结果。使用多重流式免疫测定（MFI）对患者进行梅毒螺旋体抗体（TPA）检测，并通过快速血浆反应素（RPR）确认阳性结果。主要实施结果是每月梅毒检测数量，主要临床结果是每月梅毒诊断数量（定义为 TPA MFI 和 RPR 阳性）。我们进行了中断时间序列分析，以评估随着时间的推移实施警报的效果。结果 在实施前和实施后分别对 494 名和 1106 名独特患者进行了梅毒检测。实施警报后，梅毒检测每月增加 55.6 次（95% CI 45.9 至 65.3，p<0.001）。 在实施后阶段使用警报进行测试的患者要年轻得多（差异：14 岁（95% CI 12 至 15）），并且更有可能是女性（差异：15%（95% CI 8 至 21））与通过临床医生发起的检测进行检测的患者相比，非洲裔美国人（差异：11%（95% CI 5 至 17））。梅毒推定诊断从 3.4 例/月增加到 7.9 例/月（差异为 4.5（95% CI 2.2 至 6.9），p<0.001）。结论 我们的研究表明，使用有针对性的 EHR 警报测试方案可以增加梅毒测试和诊断，并可能减少临床医生在测试中的偏差。可根据合理要求提供数据。将根据合理要求提供数据。如需数据查询，请联系该研究的资深作者 Larissa May 博士。