ORIGINAL ARTICLE

Comprehensive drug screening in decision making of patients attending the emergency department for suspected drug overdose

A Fabbri¹, G Marchesini², A M Morselli-Labate³, S Ruggeri⁴, M Fallani⁵, R Melandri⁵, V Bua⁶, A Pasquale⁷ and A Vandelli¹

¹ Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda Unità Sanitaria Locale di Forl, Italy
² Cattedra di Malattie del Metabolismo, Università degli Studi di Bologna, Italy
³ Dipartimento di Medicina Interna e Gastroenterologia, Università degli Studi di Bologna
⁴ Laboratorio di Patologia Clinica Ospedale GB Morgagni
⁵ Dipartimento Emergenza Accettazione, Azienda Ospedaliera Policlinico S Orsola-Malpighi, Bologna, Italy
⁶ Servizio di Pronto Soccorso, Azienda Unità Sanitaria Locale Bologna Sud, Bazzano, Bologna, Italy
⁷ Servizio di Pronto Soccorso, Medicina d'Urgenza e Tossicologia Clinica, Ospedale Maggiore, Azienda Unità Sanitaria Locale Città di Bologna, Italy

Correspondence to:
Correspondence to:
Dr A Fabbri, Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda USL di Forl, 1, P le Solieri, I-47100 Forl, Italy;
andfabbri{at}libero.it

Objectives: This study aimed to evaluate the usefulness of a comprehensive drug screening method as a first line diagnostic tool on clinical decision making in patients attending an emergency department for suspected drug overdose in terms of agreement between physicians on patients' disposal.

Methods: Five emergency physicians retrospectively evaluated the records of 142 adult patients, admitted to the emergency department of a community hospital for suspected drug overdose. They were asked for an expert opinion on patients' disposal at the end of the observation period, based on paired records, with/without the results of a comprehensive drug screening.

Results: In the absence of the drug screening, a very poor agreement ( statistics) was observed between physicians. When the drug screening was available, the interobserver agreement for decision on patients' disposal increased to the fair to good range (global agreement: from 0.238 (0.019) to 0.461 (0.020) (mean(SE)); p<0.001). The agreement also increased when admission to an intensive care unit, to a general ward, and discharge from hospital were separately analysed. The availability of drug screening would have saved 21.7% of hospital admissions and 53.3% of high dependency and/or intensive care unit admissions.

Conclusion: Comprehensive drug screening adds to decision making for patients attending an emergency department for suspected drug overdose, improving agreement among physicians on patients' disposal and potentially saving hospital resources.

Keywords: drug screening

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This article has been cited by other articles:

• Greller, H A, Barrueto, F Jr (2004). Comprehensive drug screening. Emerg. Med. J. 21: 646-646 [Full Text]