Utility of Routine Drug Screening in a Psychiatric Emergency Setting

Abstract

Routine urine drug screening in a psychiatric emergency service did not affect disposition or the subsequent length of inpatient stays. The results do not support routine use of drug screens in this setting.

Patients with Suicidal Ideation and Evidence of Alcohol Use are Discharged at Higher Rates from the Emergency Department

“…In theory, of course, knowledge about exposure to drugs of abuse could potentially alter diagnosis and disposition from the emergency department. However, this study confirms several previous studies which have indicated that this is not the case (Table 4); [5][6][7][23][24][25][26]. Many of these studies are not prospective and have not attempted to account for other factors which might impact admission decisions by emergency clinicians.…”

“…This may be problematic as detailed below. However, based on studies of this type, the American College of Emergency Physicians in a 2006 guideline stated that "Routine urine toxicologic screens for drugs of abuse in alert, awake, csooperative patients do not affect ED management and need not be performed as [26] 392 PES Prospective randomized PES No *see text for description; Before/after design asking physicians whether results of UDS altered care plans; Other labs and elements of the history/physical included in analysis; physicians allowed to order screens for all patients based on clinical judgment. …”

Drugs of abuse among acute psychiatric and medical admissions: laboratory based identification of prevalence and drug influence

“…The latter study concluded that the impact of substance abusing patients was substantial; they presented often with acutely suicidal conditions, required high levels of behavioural management, spent more time in the emergency department, but had less need for psychiatric hospitalization. When laboratory findings were compared with patient and physician reports, significant discrepancies were reported in most studies, and better agreement in some (141). Some studies concluded in favor of the routine use on-site urine screening tests (134,140), whereas others did not (141).…”

“…Among studies of emergency psychiatry and substance use, many have been performed in US psychiatric emergency departments (134)(135)(136)(137)(138)(139)(140)(141). These studies report urine detection rates of "any drug" ranging from 21% -62%.…”

“…When laboratory findings were compared with patient and physician reports, significant discrepancies were reported in most studies, and better agreement in some (141). Some studies concluded in favor of the routine use on-site urine screening tests (134,140), whereas others did not (141). A recent review, however, concluded not in favor of using on-site urine tests among emergency department patients (30).…”