Emerg Med J 20:25-28 doi:10.1136/emj.20.1.25
  • Original Article

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

  1. A Fabbri1,
  2. G Marchesini2,
  3. A M Morselli-Labate3,
  4. S Ruggeri4,
  5. M Fallani5,
  6. R Melandri5,
  7. V Bua6,
  8. A Pasquale7,
  9. A Vandelli1
  1. 1Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda Unità Sanitaria Locale di Forl, Italy
  2. 2Cattedra di Malattie del Metabolismo, Università degli Studi di Bologna, Italy
  3. 3Dipartimento di Medicina Interna e Gastroenterologia, Università degli Studi di Bologna
  4. 4Laboratorio di Patologia Clinica Ospedale GB Morgagni
  5. 5Dipartimento Emergenza Accettazione, Azienda Ospedaliera Policlinico S Orsola-Malpighi, Bologna, Italy
  6. 6Servizio di Pronto Soccorso, Azienda Unità Sanitaria Locale Bologna Sud, Bazzano, Bologna, Italy
  7. 7Servizio di Pronto Soccorso, Medicina d'Urgenza e Tossicologia Clinica, Ospedale Maggiore, Azienda Unità Sanitaria Locale Città di Bologna, Italy
  1. Correspondence to:
 Dr A Fabbri, Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda USL di Forl, 1, P le Solieri, I-47100 Forl, Italy;
  • Accepted 14 June 2002


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 (κ 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.


  • Funding: none.

  • Conflicts of interest: none.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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