Erdmann Andreas, Werner Dominique, Hugli Olivier, Yersin Bertrand
mergency Department, University Hospital (CHUV), Lausanne, Switzerland; Angiology Department, University Hospital (CHUV), Lausanne, Switzerland.
Laboratory of clinical chemistry, University Hospital (CHUV), Lausanne, Switzerland.
Swiss Med Wkly. 2015 Dec 28;145:w14242. doi: 10.4414/smw.2015.14242. eCollection 2015.
Drug poisoning is a common cause for attendance in the emergency department. Several toxicology centres suggest performing urinary drug screens, even though they rarely influence patient management.
Measuring the impact on patient management, in a University Emergency Department with approximately 40 000 admissions annually, of a rapid urinary drug screening test using specifically focused indications. Drug screening was restricted to patients having a first psychotic episode or cases demonstrating respiratory failure, coma, seizures, a sympathomimetic toxidrome, severe opiate overdose necessitating naloxone, hypotension, ventricular arrhythmia, acquired long QT or QRS >100 ms, and high-degree heart block.
Retrospective analysis of Triage® TOX drug screen tests performed between September 2009 and November 2011, and between January 2013 and March 2014.
A total of 262 patients were included, mean age 35 ± 14.6 (standard deviation) years, 63% men; 29% poisoning with alcohol, and 2.3% deaths. Indications for testing were as follows: 34% were first psychotic episodes; 20% had acute respiratory failure; 16% coma; 8% seizures; 8% sympathomimetic toxidromes; 7% severe opioid toxidromes; 4% hypotension; 3% ventricular arrhythmias or acquired long QT intervals on electrocardiogram. A total of 78% of the tests were positive (median two substances, maximum five). The test resulted in drug-specific therapy in 6.1%, drug specific diagnostic tests in 13.3 %, prolonged monitoring in 10.7% of methadone-positive tests, and psychiatric admission in 4.2%. Overall, 34.3% tests influenced patient management.
In contrast to previous studies showing modest effects of toxicological testing, restricted use of rapid urinary drug testing increases the impact on management of suspected overdose patients in the ED.
药物中毒是急诊科就诊的常见原因。多个毒理学中心建议进行尿液药物筛查，尽管其对患者管理的影响甚微。
在一所每年约有40000例住院患者的大学急诊科，采用针对性明确的指征进行快速尿液药物筛查试验，评估其对患者管理的影响。药物筛查仅限于首次出现精神病发作的患者或表现为呼吸衰竭、昏迷、癫痫发作、拟交感神经综合征、需要纳洛酮治疗的严重阿片类药物过量、低血压、室性心律失常、获得性长QT或QRS>100毫秒以及高度房室传导阻滞的病例。
对2009年9月至2011年11月以及2013年1月至2014年3月期间进行的Triage® TOX药物筛查试验进行回顾性分析。
共纳入262例患者，平均年龄35±14.6（标准差）岁，男性占63%；29%为酒精中毒，2.3%死亡。检测指征如下：34%为首次精神病发作；20%有急性呼吸衰竭；16%昏迷；8%癫痫发作；8%拟交感神经综合征；7%严重阿片类药物综合征；4%低血压；3%室性心律失常或心电图显示获得性长QT间期。共78%的检测结果为阳性（中位数为两种物质，最多五种）。该检测导致6.1%的患者接受了特定药物治疗，13.3%的患者进行了特定药物诊断检测，10.7%的美沙酮阳性检测患者接受了延长监测，4.2%的患者被收住精神病科。总体而言，34.3%的检测影响了患者管理。
与之前显示毒理学检测作用有限的研究不同，限制使用快速尿液药物检测可增加对急诊科疑似药物过量患者管理的影响。
