Evaluation of the initiation of urine drug screens intended for use in transfer patients

Vakkalanka, J. Priyanka; Rushton, William F.; Hardison, Lewis S.; Bishop, Matthew; Haverstick, Doris M.; Holstege, Christopher P.

doi:10.1016/j.ajem.2014.06.011

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…[11][12][13][14] However, in these papers the patients' characteristics differenced from the present study including lower number of unconscious patients and other than poisoned patients. [11][12][13] In the present study, the patient demographics, causes of admissions, rate of ICU admissions, and the outcome are comparable with the Norwegian study by Lund et al published in 2012. 5 Corresponding with this Norwegian study, the need for specific therapies or extracorporeal treatment was low also in our material.…”

Section: Discussioncontrasting

confidence: 52%

“…9,10 However, the evidence supporting the use of toxicological screenings is lacking. There are studies questioning the use of screenings, but they are with limited number of patients or including also not poisoned patients [11][12][13] or conducted with pediatric population. 14 The outcome of the patient with acute drug poisoning is good, but the impact of the used screenings on the outcome is unclear.…”

Section: Introductionmentioning

confidence: 99%

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A retrospective analysis of the impact of toxicological diagnostics on clinical decision making in cases of acute drug poisoning

2017

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The outcome of acute drug poisoning is good. In only a few occasions specific treatments are needed. Toxicological screenings are recommended when acute drug poisoning is suspected. In this retrospective observational study the impact of routine screening on treatment decisions was analyzed. All patients with acute drug poisoning admitted to the emergency department of our university hospital during one year (2013) were retrospectively analyzed. The patients were categorized into two groups: those who received specific therapies due to the poisoning and those who received only symptomatic treatment. Results: there were a total of 318 cases with acute drug poisoning of which 120 led to intensive care treatment. Toxicological screening was performed in 225 cases (70.8%). The screening tests were more often taken from patients who were unconscious (89%) or had altered consciousness (79%) than from patients with normal consciousness (63%, P<0.001). The rate of specific treatment was higher among screened patients compared with patients without screening (18.7 vs 1.1%, P<0.001). However, unexpected screening results were found in 37 of the 225 screened patients out of whom only 6 cases received specific treatment. Most patients with acute drug poisoning were toxicologically screened, but every sixth had an unexpected finding. The rate of patients with unexpected screening result receiving specific treatment was low.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of the impact of toxicological diagnostics on clinical decision making in cases of acute drug poisoning

2017

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“…Toxicologic testing offers advantages, but is inadequately sensitive for some substances and/or patterns of usage may be falsely positive for others, and does not differentiate between therapeutic and non-therapeutic use. 49,50 Nonetheless, one study has examined substance use prevalence according to self-report and as corrected by toxicologic assay. The difference between these two measures varied by substance but was typically on the order of 2 to 5 fold greater when measured directly.…”

Section: Limitationsmentioning

confidence: 99%

Substance Use Disorder in the Emergency Department: Approaches to Estimating Prevalence

Punches

Hart

Lindsell

et al. 2019

Preprint

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Background: Understanding the prevalence of substance use disorder (SUD) in emergency department (ED) settings could facilitate prevention and treatment responses to the epidemic. However, little information is available on the true prevalence of SUD in the ED population. We characterized 1) methods for determining the prevalence of substance use and SUDs within an ED, and 2) the degree to which prevalence differs between geographically proximate EDs. Methods: This cross-sectional, multi-hospital study analyzed data from prior studies and electronic health records (EHR). Our data sources included 1) interviews of a population-based sample of ED patients, 2) chart review for a cohort of ED patients, and 3) ICD-9 codes from an urban, academic trauma center. In addition, ICD-9 codes were obtained for three geographically proximate hospitals of differing type. The sampling methods and ED settings were compared descriptively in terms of their population characteristics and estimated prevalence of SUDs. Results: Prevalence of SUDs at the urban academic center was extremely high, particularly when measured by prospective survey, but also with chart review. Use over the prior year (binge drinking, illicit drug use, or treatment for alcohol or drug use) as determined by self-report and chart review respectively was: 41.9% and 15.2% for alcohol, 36.2% and 21.6% for drugs, and 59.2% and 30.4% for either. Estimates using ICD-9 codes indicated a far lower prevalence of substance use and suggest differences between EDs. Conclusions: SUDs are highly prevalent in ED populations, though significant variability between EDs is likely. SUDs are infrequently coded, suggesting that clinicians may be unaware of SUDs, or that discharge coding is insufficient to understand and respond to SUDs. Feasible and efficacious methods of identification and documentation of SUDs is an urgent priority to aid efforts to facilitate health services planning and quality improvement, and enable pragmatic clinical trials.

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Toxicological Analysis for Cocaine Use

Peres

Verhaeghe²,

Scurlock³

et al. 2017

The Neuroscience of Cocaine

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Evaluation of the initiation of urine drug screens intended for use in transfer patients

Cited by 5 publications

References 11 publications

A retrospective analysis of the impact of toxicological diagnostics on clinical decision making in cases of acute drug poisoning

A retrospective analysis of the impact of toxicological diagnostics on clinical decision making in cases of acute drug poisoning

Substance Use Disorder in the Emergency Department: Approaches to Estimating Prevalence

Toxicological Analysis for Cocaine Use

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