The role of the toxicology laboratory in emergency medicine.II: Study of an integrated approach.

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.