The rapid urinary drug toxicology screen in the emergency room: a useful tool ?

Détails

ID Serval
serval:BIB_18E846EF3A52
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Institution
Titre
The rapid urinary drug toxicology screen in the emergency room: a useful tool ?
Titre de la conférence
Gemeinsame Jahrestagung Schweizerische Gesellschaft für Intensivmedizin, Schweizerische Gesellschaft für Pulmonale Hypertonie, Gesellschaft für klinische Ernährung der Schweiz, Schweizerische Gesellschaft für Notfall- und Rettungsmedizin, Schweizerische Interessengemeinschaft für Intensivpflege, Gast: Schweizerische Interessengemeinschaft Notfallpflege
Auteur⸱e⸱s
Erdmann A., Werner D., Yersin B., Hugli O.
Adresse
Interlaken, Schweiz, 8.-10. September 2011
ISBN
1424-4985
ISSN-L
1424-4977
Statut éditorial
Publié
Date de publication
2011
Volume
11
Série
Swiss Medical Forum
Pages
18S
Langue
anglais
Résumé
Intoxications are a frequent problem in the ER. In the vast majorityof cases, supportive treatment is sufficient. Severe intoxications withunknown agents are considered an indication for a urinary drug screen,and are recommended by several toxicology centers. However, theirusefulness for patient management remains uncertain.Study objectives: Evaluation of the impact of a urinary drug screen(Biosite Triage TOX Drug Screen) testing 11 substances(acetaminophen, amphetamines, methamphetamines, barbiturates,benzodiazepines, cocaïne, methadone, opioids, phencyclidine,cannabis, tricyclic antidepressants) on initial adult patient managementin the emergency department of a university hospital with ~35.000annual admissions.Methods: Observational retrospective analysis of all tests performedbetween 09/2009 and 09/2010. A test utility was defined as useful if itresulted in the administration of a specific antidote (Flumazenil/Naloxone), the use of a quantitative confirmatory toxicologic test, or achange in patient's disposition.Results: 57 tests were performed. Patient age was 32 ± 11 (SD) years;58% were men; 30% were also intoxicated with alcohol. Two patientsdied (3.5%): the first one of a diphenhydramin overdose, the other of ahypertensive intracerebral hemorrhage believed to be caused cocaineabuse but a negative urine test. Test indications were: 54% firstpsychotic episode; 25% acute respiratory failure; 18% coma; 12%seizure; 11% opioids toxidrome; 7% sympathicomimetic toxidrome; 5%hypotension; 4% ventricular arrhythmia (VT, VF, torsades de pointes)or long QT. 75% of tests were positives for >=1 substance (mean 1.7 ±0.9). 47% of results were unexpected by history. 18% of resultsinfluenced patient management: 7% had a negative test that confirmedthe diagnosis of endogenous psychosis in a first psychotic episode, andallowed transfer to psychiatry; 5% received flumazenil/naloxone;2% had an acetaminophen blood level after a positive screen; finally,4% had an unexpected methadone abuse that required prolongationof hospital stay.Conclusions: A rapid urinary toxicologic screen was seldom used inour emergency department, and its impact on patient managementwas marginal: only one in 6 tests influenced treatment decisions.
Création de la notice
23/01/2012 17:00
Dernière modification de la notice
20/08/2019 12:49
Données d'usage