HUMAN-IMMUNODEFICIENCY-VIRUS AMONG TRAUMA PATIENTS IN NEW-YORK-CITY

Study objective: To determine the HIV seroprevalence rates in relation to the demographic characteristics of victims, cause of death, and to xicology findings in a sample of victims of violence and accidents who presented to emergency departments before death. Methods: This descri ptive survey of a complete 3-year sample of homicides and accidents wa s conducted in 5 boroughs of New York City (population 7,322,564). Per sons 15 years of age and older injured by intentional violence or acci dents (excluding drug overdoses, falls from short heights, and suicide s) who presented to hospitals, died, and were sent to the medical exam iner were included. Standard methods were used to test plasma and seru m samples for HIV and cocaine or its metabolite. chi(2) Tests compared HIV seroprevalence across groups according to demographic characteris tics and toxicology findings. logistic regression analysis was done fo r those variables found to be significant with chi(2) tests. All stati stical tests were conducted with 2-tailed alpha levels of .05. Results : Among the 1,242 subjects in the sample, 90 (7.2%) had positive findi ngs. Male patients (8%) had higher rates than female patients (3.4%). HIV rates were highest among patients 35 to 44 years of age (20.8%), f ollowed by the 45- to 54-year age group (9.6%) and 25- to 34-year age group (8.1%). Victims of homicide (8.2%) and accidents other than moto r vehicle crashes (10.5%) had higher rates than victims of motor vehic le crashes (4%). Patients with positive results for cocaine (16.3%) we re more likely than those with negative result (5.8%) to be HIV positi ve. There were no statistically significant differences by race, excep t that no Asians were HIV positive. logistic regression analysis found that only age and positive cocaine results, not sex and race, were re lated to increased risk of HIV infection. Conclusion: We found the rat e of HIV infection among victims of fatal trauma was significant, espe cially in those with evidence of cocaine use. The HIV infection rate a pproximates the high end of the range of HIV rates found in studies be fore 1990. It further emphasizes the need for use of universal precaut ions in the care of trauma patients.