Perrone J, Hollander J E, Shaw L, De Roos F
Hospital of the University of Pennsylvania, Department of Emergency Medicine, Philadelphia 19104, USA.
J Toxicol Clin Toxicol. 1999;37(6):769-72. doi: 10.1081/clt-100102454.
Screening for acetaminophen toxicity is recommended in almost all cases of self poisoning. We compared a qualitative urine acetaminophen screen to the quantitative serum acetaminophen to test the hypothesis that a negative urine acetaminophen screen would be predictive of a negative serum acetaminophen level.
All adults with intentional ingestions evaluated in our Emergency Department during 1995 were retrospectively identified based on Emergency Department International Classification of Disease--9th edition codes. Laboratory data from each patient including serum and urine toxicologic assays were examined. Predictive properties of urine acetaminophen screens for serum acetaminophen were evaluated.
A total of 88 patients were identified who had both a serum acetaminophen and a urine acetaminophen performed. The sensitivity of the urine acetaminophen screen was 100% (95% CI 72-100%) and the specificity was 87% (95% CI 80-95%). All patients with negative urine acetaminophen screens had negative serum acetaminophen levels (negative predictive value 100%; 95% CI 96-100%). Accuracy of the urine acetaminophen screen was 89%.
A negative urine acetaminophen screen was highly predictive of negative serum acetaminophen levels. It is possible that negative urine acetaminophen screens may obviate the need for 4-hour quantitative serum levels. Further validation in a prospective study is needed.
几乎所有的自我中毒病例均建议进行对乙酰氨基酚毒性筛查。我们将定性尿液对乙酰氨基酚筛查与定量血清对乙酰氨基酚检测进行比较，以验证阴性尿液对乙酰氨基酚筛查可预测血清对乙酰氨基酚水平为阴性这一假设。
根据急诊科国际疾病分类第九版编码，对1995年期间在我院急诊科接受评估的所有故意服药的成年人进行回顾性识别。检查每位患者的实验室数据，包括血清和尿液毒理学检测结果。评估尿液对乙酰氨基酚筛查对血清对乙酰氨基酚的预测特性。
共识别出88例同时进行了血清对乙酰氨基酚和尿液对乙酰氨基酚检测的患者。尿液对乙酰氨基酚筛查的灵敏度为100%（95%可信区间72 - 100%），特异性为87%（95%可信区间80 - 95%）。所有尿液对乙酰氨基酚筛查结果为阴性的患者血清对乙酰氨基酚水平均为阴性（阴性预测值100%；95%可信区间96 - 100%）。尿液对乙酰氨基酚筛查的准确性为89%。
阴性尿液对乙酰氨基酚筛查对血清对乙酰氨基酚水平为阴性具有高度预测性。阴性尿液对乙酰氨基酚筛查可能无需检测4小时后的血清定量水平。需要在前瞻性研究中进一步验证。
