Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA.
Drug Alcohol Depend. 2022 Jan 1;230:109195. doi: 10.1016/j.drugalcdep.2021.109195. Epub 2021 Nov 26.
Most hospital urine toxicology screens detect a fixed, limited set of common substances. These tests are fast and accurate but may miss emerging trends in substance use in the community and clinical acumen alone is insufficient for identifying new substances.
This prospective cohort study examined de-identified urine specimens obtained from patients visiting the Emergency Department (ED) at Prince George's Hospital Center (PGHC), between October 15, 2019 to November 6, 2019 and tested positive for one or more substances. The Emergency Department Drug Surveillance System (EDDS) collects quarterly exports from de-identified electronic health records (EHRs) containing urinalysis results for drug related ED visits. We performed a feasibility study of a new urine specimen submission by collecting a stratified sample of 151 urine specimens from PGHC ED patients. The specimens were tested for 240 drugs using liquid chromatography-tandem mass spectrometry (LC-MS/MS). This paper presents a comparison between the PGHC and expanded testing results.
The expanded urinalysis panel found more cocaine (37% vs. 20%; p < 0.01) and benzodiazepine positives (21% vs. 11%; p < 0.05) than would have been detected by the hospital screen. Additionally, the expanded toxicology panel identified fentanyl in 4-14% of the samples.
The EHR data submitted to EDDS from the hospital urine toxicology screen correctly identified hospital substance use patterns over the approximate 1 month study period. The expanded testing also uncovered drugs that the hospital might consider adding to their routine screen. EDDS is a feasible system for monitoring and confirming recent substance use trends among ED patients.
大多数医院的尿液毒理学检测只能检测到固定的、有限的一组常见物质。这些测试快速且准确，但可能会错过社区中新兴的物质使用趋势，仅凭临床敏锐度不足以识别新物质。
本前瞻性队列研究检查了 2019 年 10 月 15 日至 11 月 6 日期间在乔治王子医院中心（PGHC）急诊科就诊的患者的尿液标本，这些尿液标本均为阳性，检测出一种或多种物质。急诊科药物监测系统（EDDS）每季度从包含急诊科药物相关就诊尿液分析结果的去识别电子健康记录（EHR）中导出数据。我们通过从 PGHC 急诊科患者中收集分层的 151 份尿液标本，对新的尿液标本提交进行了可行性研究。使用液相色谱-串联质谱法（LC-MS/MS）对这些标本进行了 240 种药物的检测。本文介绍了 PGHC 和扩展检测结果之间的比较。
与医院的筛查相比，扩大的尿液分析面板发现了更多的可卡因（37%对 20%；p<0.01）和苯二氮䓬阳性（21%对 11%；p<0.05）。此外，扩展毒理学面板在 4-14%的样本中发现了芬太尼。
从医院尿液毒理学检测向 EDDS 提交的 EHR 数据正确地识别了医院在大约 1 个月研究期间的物质使用模式。扩展检测还发现了医院可能考虑纳入常规筛查的药物。EDDS 是监测和确认急诊科患者近期物质使用趋势的可行系统。
