Hepler B R, Sutheimer C A, Sunshine I
J Toxicol Clin Toxicol. 1984;22(6):503-28. doi: 10.3109/15563658408992581.
The utility of the toxicology laboratory in emergency medicine is directly related to both establishing communication between the toxicology laboratory and the clinical staff, and to providing reliable toxicology data while the diagnostic process is still in progress. When 604 patients, on whom a "complete toxicology screen" was requested, were evaluated using qualitative probes involving chemical spot tests, immunoassay, TLC and/or selected GC/HPLC methods, the resulting data were demonstrated to be of value. The ability of the clinician to accurately predict which, if any, of a large number of intoxicants were present in a given patient, was found to be minimal and as a result these combined tests were found to be essential in facilitating a proper diagnosis. Additionally, it was found that using only chemical spot tests, immunoassay and TLC in a combined qualitative approach detected 94-98% of all the substances eventually found within the population when it was further studied using more sophisticated instrumental methods. The integrated approach involving the initial establishment of a dialogue between the clinician and the toxicologist, use of simple qualitative analytical probes, confirmation of positive findings and prompt reporting of toxicology data is a viable way in which meaningful toxicology support can be provided while the diagnostic process is still underway.
毒理学实验室在急诊医学中的作用，直接关系到在毒理学实验室与临床工作人员之间建立沟通，以及在诊断过程仍在进行时提供可靠的毒理学数据。当对604名要求进行“完整毒理学筛查”的患者，使用涉及化学斑点试验、免疫测定、薄层色谱法和/或选定的气相色谱/高效液相色谱法的定性检测方法进行评估时，结果表明所得到的数据是有价值的。临床医生准确预测某一特定患者体内是否存在大量中毒物质中的哪些物质的能力被发现极低，因此，这些联合检测被认为对于促进正确诊断至关重要。此外，研究发现，当使用更复杂的仪器方法对人群进行进一步研究时，采用化学斑点试验、免疫测定和薄层色谱法相结合的定性方法能检测出最终在人群中发现的所有物质的94% - 98%。临床医生与毒理学家之间最初建立对话、使用简单的定性分析检测方法、对阳性结果进行确认以及及时报告毒理学数据的综合方法，是一种可行的方式，能够在诊断过程仍在进行时提供有意义的毒理学支持。
