Focused use of drug screening in overdose patients increases impact on management.

Détails

Ressource 1Télécharger: 26709671.pdf (603.67 [Ko])
Etat: Public
Version: Final published version
ID Serval
serval:BIB_949FD877E50A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Focused use of drug screening in overdose patients increases impact on management.
Périodique
Swiss Medical Weekly
Auteur(s)
Erdmann A., Werner D., Hugli O., Yersin B.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
145
Pages
w14242
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
UNLABELLED: Drug poisoning is a common cause for attendance in the emergency department. Several toxicology centres suggest performing urinary drug screens, even though they rarely influence patient management.
STUDY OBJECTIVES: Measuring the impact on patient management, in a University Emergency Department with approximately 40 000 admissions annually, of a rapid urinary drug screening test using specifically focused indications. Drug screening was restricted to patients having a first psychotic episode or cases demonstrating respiratory failure, coma, seizures, a sympathomimetic toxidrome, severe opiate overdose necessitating naloxone, hypotension, ventricular arrhythmia, acquired long QT or QRS >100 ms, and high-degree heart block.
METHODS: Retrospective analysis of Triage® TOX drug screen tests performed between September 2009 and November 2011, and between January 2013 and March 2014.
RESULTS: A total of 262 patients were included, mean age 35 ± 14.6 (standard deviation) years, 63% men; 29% poisoning with alcohol, and 2.3% deaths. Indications for testing were as follows: 34% were first psychotic episodes; 20% had acute respiratory failure; 16% coma; 8% seizures; 8% sympathomimetic toxidromes; 7% severe opioid toxidromes; 4% hypotension; 3% ventricular arrhythmias or acquired long QT intervals on electrocardiogram. A total of 78% of the tests were positive (median two substances, maximum five). The test resulted in drug-specific therapy in 6.1%, drug specific diagnostic tests in 13.3 %, prolonged monitoring in 10.7% of methadone-positive tests, and psychiatric admission in 4.2%. Overall, 34.3% tests influenced patient management.
CONCLUSIONS: In contrast to previous studies showing modest effects of toxicological testing, restricted use of rapid urinary drug testing increases the impact on management of suspected overdose patients in the ED.
Mots-clé
Adolescent, Adult, Aged, Aged, 80 and over, Drug Overdose/diagnosis, Drug Overdose/urine, Drug-Related Side Effects and Adverse Reactions/diagnosis, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Retrospective Studies, Switzerland, Young Adult
Pubmed
Web of science
Open Access
Oui
Création de la notice
21/09/2016 19:07
Dernière modification de la notice
20/08/2019 15:57
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