Elsevier

Annals of Emergency Medicine

Volume 16, Issue 11, November 1987, Pages 1206-1216
Annals of Emergency Medicine

Original contribution
Impact of drug screening in suspected overdose

https://doi.org/10.1016/S0196-0644(87)80225-1Get rights and content

We studied how emergency qualitative drug screens were ordered and used during the evaluation of 405 consecutive adult patients presenting to a metropolitan emergency department with suspected drug intoxication. Physicians completed a two-part questionnaire outlining diagnosis, diagnostic certainty, suspected drug(s), and management plans immediately following initial evaluation and again at the time of ED disposition. Screen results were reviewed prior to ED disposition in 361 (89%) cases. We found that qualitative drug screens were associated with substantial changes in diagnostic certainty, as measured by changes in probability estimates and changes in absolute mean log-likelihood ratios. In 196 cases for which all data were recorded prospectively, drug screens excluded a diagnosis of drug intoxication or specifically suspected drugs in 81 cases (41%), but identified previously unsuspected drugs in only 21 cases (11%, P < .001). Management changes followed qualitative drug screen results in 16 of 361 cases overall (4.4%), but seven of these were also associated with diagnostic quantitative serum drug levels. Potentially critical interventions were begun in two cases following positive screens but delayed in another due to a falsely negative screen. Guidelines for more efficient test utilization are proposed.

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    Presented at the Southern Section, American Federation for Clinical Research, New Orleans, Louisiana, February 1986.

    1

    Dr Kellermann was a fellow in the University of Washington Robert Wood Johnson Clinical Scholars Program at the time this work was completed. The views expressed are those of the authors and do not necessarily reflect those of the Robert Wood Johnson Foundation.

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