Lynch Kara L
Department of Laboratory Medicine, University of California San Francisco, 1001 Potrero Ave., Building 5, 2M16, San Francisco, CA 94110, USA.
J Mass Spectrom Adv Clin Lab. 2023 Mar 2;28:75-79. doi: 10.1016/j.jmsacl.2023.02.011. eCollection 2023 Apr.
Drug testing typically follows a one-size-fits-all approach that is inadequate in some clinical scenarios, such as child maltreatment, neglect, and unintentional drug exposure. Results from immunoassay-based testing, which are non-specific, insensitive, and far from comprehensive, can lead to unintended consequences for children and their families.
The objective of this retrospective case series study is to evaluate the utility of real-time (0-1 day) comprehensive drug testing as an alternative to immunoassay-based testing in the pediatric acute care setting.
Comprehensive drug testing results obtained by mass spectrometry testing and associated medical data for all pediatric cases (0-12 years) at one institution from 2019 to 2022 were included in the analysis. The final case series (n = 7) included all cases from patients <3 years with comprehensive drug testing results that were inconsistent with medication history and/or toxicology results by immunoassay.
Comprehensive drug testing by mass spectrometry was ordered for 174 urine and blood samples representing 97 patients (0-12 years) from 2019 to 2022. Of these, 76 cases were from patients <3 years old; results were consistent with medication history and confirmatory for immunoassay results (n = 34), consistent with medication history (n = 14), confirmatory for immunoassay results (n = 10), negative (n = 9), or medical history was incomplete (n = 2). The remaining 7 cases were included in the final case series.
The cases highlight the value of real-time comprehensive drug testing in acute pediatric cases. Testing results can rule out toxic exposure from the diagnostic differential when negative, and lead to appropriate medical and social interventions when positive.
药物检测通常采用一刀切的方法，在某些临床情况下并不适用，如虐待儿童、忽视儿童以及意外药物暴露。基于免疫分析的检测结果不具有特异性、敏感性不足且远非全面，可能会给儿童及其家庭带来意想不到的后果。
本回顾性病例系列研究的目的是评估实时（0 - 1天）全面药物检测作为儿科急性护理环境中基于免疫分析检测的替代方法的效用。
分析了2019年至2022年在一家机构对所有儿科病例（0 - 12岁）通过质谱检测获得的全面药物检测结果及相关医疗数据。最终病例系列（n = 7）包括所有年龄小于3岁、全面药物检测结果与用药史和/或免疫分析毒理学结果不一致的患者病例。
2019年至2022年期间，对代表97名患者（0 - 12岁）的174份尿液和血液样本进行了质谱全面药物检测。其中，76例来自3岁以下患者；结果与用药史一致且免疫分析结果得到确认（n = 34），与用药史一致（n = 14），免疫分析结果得到确认（n = 10），阴性（n = 9），或病史不完整（n = 2）。其余7例纳入最终病例系列。
这些病例凸显了实时全面药物检测在儿科急性病例中的价值。检测结果为阴性时可排除诊断鉴别中的有毒暴露，为阳性时可导致适当的医疗和社会干预。
