Rosano Thomas G, Islam S M Touhidul, Rumberger John M, Konetchy Robert M, Wood Michelle, Sorce Joseph A, Robstad Karl A, Long Heather
National Toxicology Center at Life Sciences Innovation Building, Albany, NY, United States.
Department of Pathology and Laboratory Medicine at Albany Medical Center, Albany, NY, United States.
J Mass Spectrom Adv Clin Lab. 2025 Apr 23;37:16-27. doi: 10.1016/j.jmsacl.2025.04.008. eCollection 2025 Aug.
Clinical management of drug-related emergency department (ED) visits relies on available history, toxidrome findings and drug screening. In this study, definitive drug testing is used to assess ED drug prevalence and immunoassay drug screening performance.
Definitive testing for 116 drugs and metabolites was performed on urine from 400 ED patients, with comparison to immunoassay drug screening.
Definitive testing resulted in 1,350 drug findings with prevalent use of nicotine (63%), cocaine (34%), ∆9 tetrahydrocannabinol (34%), fentanyl (17%), morphine or heroin (11%) and methamphetamine (6%). Forty percent of patients were also positive for antidepressants and 24% positive for antipsychotics. Significant patterns of co-drug use were found for cocaine, fentanyl, morphine and nicotine. Multi-serotonergic drug use was frequent, suggesting a risk for serotonin syndrome. Immunoassay performance showed high false negative rates for benzodiazepines (40%), amphetamines (38%), barbiturates (33%), opiates (25%), methadone (20%) and cocaine (16%), along with inaccuracy in phencyclidine detection. Immunoassay missed 890 of the 1,350 drug findings by definitive testing, due to either high cutoff thresholds or limited testing scope.
A high prevalence of drugs use by ED patients is evidenced with frequent co-use of illicit and therapeutic drugs and with potential for unrecognized multi-serotonergic drug interactions. This study also shows the limitations of immunoassay drug testing in both scope and sensitivity, with a high rate of undetected drug use.
The study provides evidence-based support for recommended implementation of definitive drug testing in emergency medicine as a guide to clinical management in drug-related ED visits.
药物相关急诊科（ED）就诊的临床管理依赖于现有的病史、中毒综合征表现及药物筛查。在本研究中，采用确定性药物检测来评估急诊科药物流行情况及免疫分析法药物筛查的性能。
对400例急诊科患者的尿液进行了116种药物及代谢物的确定性检测，并与免疫分析法药物筛查结果进行比较。
确定性检测发现了1350例药物检出情况，其中尼古丁（63%）、可卡因（34%）、∆9四氢大麻酚（34%）、芬太尼（17%）、吗啡或海洛因（11%）及甲基苯丙胺（6%）的使用较为普遍。40%的患者抗抑郁药检测也呈阳性，24%的患者抗精神病药检测呈阳性。发现可卡因、芬太尼、吗啡和尼古丁存在显著的联合用药模式。多血清素能药物的使用很常见，提示存在血清素综合征风险。免疫分析法的性能显示，苯二氮䓬类药物（40%）、苯丙胺类药物（38%）、巴比妥类药物（33%）、阿片类药物（25%）、美沙酮（20%）和可卡因（16%）的假阴性率较高，同时苯环己哌啶检测存在误差。由于临界值过高或检测范围有限，免疫分析法在1350例确定性检测的药物检出情况中漏检了890例。
急诊科患者药物使用的高流行率表现为非法药物与治疗药物频繁联合使用，以及存在未被识别的多血清素能药物相互作用的可能性。本研究还显示了免疫分析法药物检测在范围和灵敏度方面的局限性，未检测到的药物使用率较高。
本研究为在急诊医学中推荐实施确定性药物检测提供了循证支持，作为药物相关急诊科就诊临床管理的指南。
