Addiction Medicine Research Fellowship Program, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
Clin Toxicol (Phila). 2022 Oct;60(10):1122-1129. doi: 10.1080/15563650.2022.2117052. Epub 2022 Sep 7.
Trauma centers are required to screen patients for alcohol use, and if necessary, intervene and refer to treatment (SBIRT). Similar screening for illicit drug use is recommended but not required. Urine drug screening (UDS) underestimates problematic substance use. This study aimed to estimate the types and rates of UDS false negatives (FN) compared to comprehensive testing by liquid chromatography-mass spectrometry (LC-MS) in trauma patients.
We performed a prospective cohort study of deidentified urine samples from adult trauma and burn activation patients. Both UDS and LC-MS comprehensive testing of >200 analytes were performed by a reference laboratory on all samples. Iatrogenic medications were excluded from the FN count. Crosstab analyses were conducted for UDS versus LC-MS outcomes to establish FN types and rates. We dichotomized the results by creating an "intentionality" variable (intentional injuries by self/others versus accidental injuries). A series of crosstabs with odds ratios considered intentionality by substance class and demographics. Statistically significant variables by Chi-Square were assessed by logistic regression.
Psychoactive FN were detected in 56/100 urine samples analyzed; the most frequent included anticonvulsants (primarily gabapentin, = 13), opioid agonists ( = 12), antihistamines (primarily diphenhydramine, = 10), and phenethylamines (primarily bupropion, = 5). Nonpsychoactive FN were detected in 70/100 samples; the most common were nicotine ( = 33), caffeine ( = 23), acetaminophen ( = 22), and antidepressants ( = 12). Of substance classes included in the UDS and also tested by LC-MS, FN occurred for opiates (3%), amphetamines (5%) and opioids (25%). Polypharmacy was associated with fall injuries in elderly patients. Cocaine ( = 0.015) and cannabinoids ( = 0.002) were significantly associated with intentionality.
Our results indicate that FN for potentially important psychoactive and nonpsychoactive substances are common when toxicologic testing is limited to routine UDS in trauma patients. We recommend expanding SBIRT in this patient population to include misuse of tobacco products, prescription analgesics, and over-the-counter antihistamines.
创伤中心被要求对患者进行酒精使用筛查，如果有必要，进行干预并转介至治疗（SBIRT）。类似的非法药物使用筛查也被推荐，但并非强制性的。尿液药物筛查（UDS）低估了有问题的物质使用。本研究旨在估计在创伤患者中，与液相色谱-质谱（LC-MS）全面检测相比，UDS 假阴性（FN）的类型和比率。
我们对成年创伤和烧伤激活患者的匿名尿液样本进行了前瞻性队列研究。所有样本均由参考实验室进行 UDS 和 LC-MS 综合检测，检测 >200 种分析物。将医源性药物从 FN 计数中排除。对 UDS 与 LC-MS 结果进行交叉表分析，以确定 FN 类型和比率。我们通过创建一个“意图”变量（由自己/他人造成的蓄意伤害与意外伤害）将结果分为二项式。对物质类别和人口统计学因素进行一系列交叉表，以考虑意向性的比值比。通过卡方检验确定有统计学意义的变量，然后通过逻辑回归进行评估。
在分析的 100 个尿液样本中，检测到 56 个具有精神活性的 FN；最常见的包括抗惊厥药（主要是加巴喷丁， = 13）、阿片类激动剂（ = 12）、抗组胺药（主要是苯海拉明， = 10）和苯乙胺（主要是安非他酮， = 5）。在 100 个样本中检测到非精神活性 FN；最常见的是尼古丁（ = 33）、咖啡因（ = 23）、对乙酰氨基酚（ = 22）和抗抑郁药（ = 12）。在 UDS 中包含并通过 LC-MS 测试的物质类别中，阿片类药物（3%）、苯丙胺（5%）和阿片类药物（25%）的 FN 发生率较高。老年人跌倒损伤与多药合用有关。可卡因（ = 0.015）和大麻素（ = 0.002）与意图显著相关。
我们的研究结果表明，在创伤患者中，毒理学检测仅限于常规 UDS 时，对于潜在重要的精神活性和非精神活性物质的 FN 很常见。我们建议在该患者群体中扩大 SBIRT，以包括烟草制品、处方镇痛药和非处方抗组胺药的滥用。
