Heyerdahl F, Hovda K E, Bjornaas M A, Brørs O, Ekeberg O, Jacobsen D
Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway.
Hum Exp Toxicol. 2008 Jan;27(1):73-9. doi: 10.1177/0960327107087800.
Acute poisonings may require identification of the toxic agents. It is impossible for routine laboratories to provide a full spectrum of toxicological analyses, and clinicians should know the reliability of the clinical diagnoses of toxic agents. We performed a 1-year study of hospitalized acute poisonings to determine the agreement between the clinical assessment on admission and serum laboratory tests for eight common toxic agents. Blood samples were drawn in 665 (70%) of the 947 admissions. The total number of laboratory found agents (967) exceeded the clinically suspected (871) by 11%. The agreement between the clinical assessment and laboratory analyses was good for ethanol and paracetamol (kappa = 0.70 for both), whereas only moderate or fair for other agents (kappa 0.22-0.51). Sensitivities of the clinical assessments compared to the laboratory results were better for common than rare agents, and better for higher than lower serum concentrations. The four most common agents (ethanol, benzodiazepines, paracetamol, and opiates) had overall sensitivity of 82% for higher-than-median serum concentrations, whereas the other agents had sensitivities ranging from 14% to 71% for higher-than-median concentrations. The reliability of the clinical diagnoses varied to such an extent that agents, which are important to recognize for specific treatment, should be tested for.
急性中毒可能需要识别有毒物质。常规实验室不可能提供全面的毒理学分析，临床医生应该了解对有毒物质进行临床诊断的可靠性。我们对住院急性中毒患者进行了为期1年的研究，以确定入院时的临床评估与针对8种常见有毒物质的血清实验室检测之间的一致性。在947例入院患者中，665例（70%）采集了血样。实验室检测出的有毒物质总数（967种）比临床怀疑的（871种）超出了11%。临床评估与实验室分析之间的一致性对于乙醇和对乙酰氨基酚而言良好（两者的kappa值均为0.70），而对于其他物质仅为中等或一般（kappa值为0.22 - 0.51）。与实验室结果相比，临床评估对常见物质的敏感性高于罕见物质，对血清浓度较高的物质的敏感性高于浓度较低的物质。四种最常见的物质（乙醇、苯二氮䓬类、对乙酰氨基酚和阿片类）对于高于中位数血清浓度的总体敏感性为82%，而其他物质对于高于中位数浓度的敏感性范围为14%至71%。临床诊断的可靠性差异很大，对于特定治疗而言重要的可识别物质应进行检测。
