Clinical value of drugs of abuse point of care testing in an emergency department setting

Lager, P.S.; Jonge, Milly E Attema-de; Gorzeman, M.P.; Kerkvliet, L.E.; Franssen, Eric J. F.

doi:10.1016/j.toxrep.2017.12.001

Cited by 19 publications

(6 citation statements)

References 34 publications

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“…This type of analysis suggests that interference produced by hydroxychloroquine is not due to structural similarity but instead other mechanisms such as absorption interference or chemical reaction with assay reagents. Given how commonly drug of abuse screening in used in the emergency department setting [33], understanding of potential interferences are important to avoid diagnostic confusion [34]. Overdoses such as hydroxychloroquine can cause additional challenges in producing cardiovascular symptoms (e.g., arrhythmias) that may overlap with common street drugs of abuse [[35], [36], [37]] or other ingestions such as caffeine [38] or tricyclic antidepressants [39].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic pitfalls and laboratory test interference after hydroxychloroquine intoxication: A case report

et al. 2019

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Section: Discussionmentioning

confidence: 99%

Diagnostic pitfalls and laboratory test interference after hydroxychloroquine intoxication: A case report

et al. 2019

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“…One alternative method that has emerged for analysis of ethylene glycol are ethylene glycol enzymatic assays that can run on standard clinical chemistry analyzers with rapid turnaround time to determine quantitative ethylene glycol concentrations [[11], [12], [13], [14]]. It is important to note that standard drug of abuse screening panels, commonly used in emergency medicine [15], will not detect the toxic alcohols.…”

Section: Introductionmentioning

confidence: 99%

Correlation of osmolal gap with measured concentrations of acetone, ethylene glycol, isopropanol, methanol, and propylene glycol in patients at an academic medical center

Greene

Krasowski

2020

Toxicology Reports

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“…An on-site test for detecting urine GHB within minutes can be of great diagnostic value in addition to point-of-care tests for other drugs of abuse. [28][29][30][31][32][33][34][35] However, the goal of achieving a specificity and sensitivity of .90% was unmet. The GHB on-site test's specificity was at the borderline (90.0%), and its sensitivity was unacceptable (72.9%).…”

Section: Discussionmentioning

confidence: 99%

Prospective Investigation of the Performance of 2 Gamma-Hydroxybutyric Acid Tests: DrugCheck GHB Single Test and Viva-E GHB Immunoassay

Smits¹,

Gresnigt

Groen

et al. 2020

Therapeutic Drug Monitoring

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Background: Gamma-hydroxybutyric acid (GHB) is a recreational drug with central nervous system depressing effects that is often abused. A urine GHB point-of-care test can be of great diagnostic value. The objective of this prospective study was to determine the performance of the new DrugCheck GHB Single Test and the Viva-E GHB immunoassay for urine samples in emergency department patients. Methods: Patients presented to the emergency department of the OLVG hospital in Amsterdam with a Glasgow Coma Scale score ,15 and potential drug of abuse intoxication were included in the study. Between June 2016 and October 2017, 375 patients were included. Using the DrugCheck GHB Single Test (Express Diagnostics Int'l, Blue Earth, MN) and the Viva-E GHB immunoassay (Siemens Healthineers, The Hague, the Netherlands), patients' urine samples were tested for GHB (cutoff for a positive result, 10 or 50 mcg/mL GHB). To ensure quality, the results obtained were compared with those generated using a validated gas chromatography method. The tests were considered reliable if specificity and sensitivity were both .90%. Possible cross-reactivity with ethanol was investigated by analyzing ethanol concentrations in patients' samples. Results: Seventy percentage of the included patients was men, and the median age was 34 years old. The DrugCheck GHB Single Test's specificity and sensitivity were 90.0% and 72.9%, respectively, and using 50 mcg/mL as a cutoff value, its specificity and sensitivity improved to 96.7% and 75.0%, respectively. Serum and urine ethanol levels in the false-positive group were significantly higher compared with those in the true-negative group. The specificity and sensitivity of the Viva-E GHB immunoassay (cutoff value of 50 mcg/mL and excluding samples with ethanol levels $2.0 g/L) were 99.4% and 93.5%, respectively. Conclusions: The DrugCheck GHB Single Test's specificity was sufficient, whereas its sensitivity was poor, making it unsuitable for use at point-of-care. Contrarily, using 50 mcg/mL as the cutoff value and excluding samples with ethanol levels $2.0 g/L, the Viva-E GHB immunoassay showed acceptable results to detect clinically relevant GHB intoxications.

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Clinical value of drugs of abuse point of care testing in an emergency department setting

Abstract: Graphical abstract

Cited by 19 publications

References 34 publications

Diagnostic pitfalls and laboratory test interference after hydroxychloroquine intoxication: A case report

Diagnostic pitfalls and laboratory test interference after hydroxychloroquine intoxication: A case report

Correlation of osmolal gap with measured concentrations of acetone, ethylene glycol, isopropanol, methanol, and propylene glycol in patients at an academic medical center

Prospective Investigation of the Performance of 2 Gamma-Hydroxybutyric Acid Tests: DrugCheck GHB Single Test and Viva-E GHB Immunoassay

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