Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-14T11:53:14.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Screening urine for drugs of abuse in the emergency department: Do test results affect physicians’ patient care decisions?

Published online by Cambridge University Press:  21 May 2015

Jeffrey S. Eisen ,
Marco L.A. Sivilotti ,
Kirsty U. Boyd ,
Douglas G. Barton ,
Christopher J. Fortier  and
Christine P. Collier
Jeffrey S. Eisen*
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont
Marco L.A. Sivilotti
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont Department of Pharmacology and Toxicology, Queen’s University
Kirsty U. Boyd
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont
Douglas G. Barton
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont
Christopher J. Fortier
Affiliation:
Department of Family Medicine, McMaster University, Hamilton, Ont
Christine P. Collier
Affiliation:
Department of Pathology, Queen’s University
*
Department of Emergency Medicine, Queen’s University, 76 Stuart St., Kingston ON K7L 2V7; 613 548–2368, fax 613 548–1374, sivilotm@meds.queensu.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Drug abuse is a frequent factor in emergency department (ED) visits. Although commonly performed, qualitative testing of urine for drugs of abuse (u-DOA) is inherently limited in its ability to establish the identity, timing or dose of substances used. Previous studies have demonstrated these limitations, but their designs cannot be used to determine whether the results of u-DOA tests affect physicians’ patient care decisions. Our objective was to determine the impact of u-DOA testing on the care of patients who present to the ED.

Methods:

All adults 18 years of age or older who had u-DOA testing in 2 urban teaching EDs were eligible. Victims of vehicular trauma or sexual assault were excluded. Just prior to communicating the results of u-DOA testing for a patient, an investigator interviewed the ordering physician or consultant physician about the patient care plans for that patient. Test results were then revealed, and the questions immediately repeated. This design isolated the impact of knowledge of u-DOA test results on physicians’ patient care decisions. Any intended changes in patient care plans reported by the interviewed physician were compared to a priori criteria for substantive change and then subsequently reviewed by an independent expert to determine whether that change was justified.

Results:

Of the 110 u-DOA test results studied and the resultant 133 opportunities to influence physician management plans, there were 4 reported changes in management. One management change was judged to be substantive, but none of the 4 reported changes were considered by the independent expert reviewer to be justified. Urine-DOA testing thus led to a justified change in management in 0/133 instances (95% confidence interval 0%–2.3%).

Conclusions:

Urine-DOA is rarely helpful in guiding patient care decisions in the ED. The results of this study call into question the need for this test in the ED setting.

Keywords

substance abuse detectionemergency service, hospitaldiagnostic tests
Type
EM Advances • Innovations En MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 2 , March 2004 , pp. 104 - 111
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Prince, BS, Goetz, CM, Rihn, TL, Olsky, M.Drug-related emergency department visits and hospital admissions. Am J Hosp Pharm 1992;49:1696–700.Google Scholar
2.Schiller, MJ, Shumway, M, Batki, SL.Utility of routine drug screening in a psychiatric emergency setting. Psychiatr Serv 2000;51(4):474–8.Google Scholar
3.McNagny, SE, Parker, RM.High prevalence of recent cocaine use and the unreliability of patient self-report in an inner city walk-in clinic. JAMA 1992;267:1106–8.Google Scholar
4.Kwong, TC, Shearer, D.Detection of drug use during pregnancy. Obstet Gynecol Clin North Am 1998;25(1):43–64.CrossRefGoogle ScholarPubMed
5.Lindsay, MK, Carmichael, S, Peterson, H, Risby, J, Williams, H, Klein, L.Correlation between self-reported cocaine use and urine toxicology in an inner-city prenatal population. J Natl Med Assoc 1997;89(1):57–60.Google Scholar
6.Mahl, MA, Hirsch, M, Sugg, U.Verification of the drug history given by potential blood donors: results of drug screening that combines hair and urine analysis. Transfusion 2000;40(6):637–41.Google Scholar
7.Elangovan, N, Berman, S, Meinzer, A, Gianelli, P, Miller, H, Longmore, W.Substance abuse among patients presenting at an inner-city psychiatric emergency room. Hosp Community Psychiatry 1993;44(8):782–4.Google ScholarPubMed
8.Gilfillan, S, Claassen, CA, Orsulak, P, Carmody, TJ, Sweeney, JB, Battaglia, J, et al. A comparison of psychotic and nonpsychotic substance users in the psychiatric emergency room. Psychiatr Serv 1998;49(6):825–8.Google Scholar
9.Montague, RE, Grace, RF, Lewis, JH, Shenfield, GM.Urine drug screens in overdose patients do not contribute to immediate clinical management. Ther Drug Monit 2001;23:47–50.Google Scholar
10.Brett, AS.Implications of discordance between clinical impression and toxicology analysis in drug overdose. Arch Intern Med 1988;148:437–41.CrossRefGoogle ScholarPubMed
11.Byrne, AG, Pierce, A.Evaluation of six point of care tests for drugs of abuse in urine. International Association of Forensic Toxicologists Bulletin (TIAFT Bulletin) 2003;33(4):69–75.Google Scholar
12.Korn, CS, Currier, GW, Henderson, SO.“Medical clearance” of psychiatric patients without medical complaints in the emergency department. J Emerg Med 1988;18(2):173–6.Google Scholar
13.Fochtmann, LJ.Psychiatric perspectives on medical screening of psychiatric patients. Acad Emerg Med 2002;9(9):963–4.Google Scholar
14.Degutis, LC.Need for brief interventions for marijuana and alcohol use related to injuries. Acad Emerg Med 2003;10(1):62–4.CrossRefGoogle ScholarPubMed