Original Contributions
Drug screening versus history in detection of substance use in ED psychiatric patients*,**,*

Presented at the Society for Academic Emergency Medicine Annual Meeting, Boston, May 1999.
https://doi.org/10.1053/ajem.2001.20003Get rights and content

Abstract

Because self-reporting of substance use may not be reliable, physicians rely on drug screening. We tested the hypothesis that drug screening alone is sufficient to detect substance use in ED psychiatric patients. We prospectively evaluated patients receiving psychiatric consultation over 6 months ending in April 1998 in an urban medical/psychiatric ED with 42,000 annual visits. After informed consent, patients underwent a structured interview by trained research associates who queried regarding substance use in the past 3 days. This self-report was compared with urine drug screen results for 11 substances of abuse. Standard descriptive statistical techniques were used. Kappa statistics were used to assess concordance between history and drug screens. Two hundred eighteen patients participated, 124 had a urine drug screen obtained. Patients with and without urine drug screens were similar with respect to age (34.9 versus 34.9 years, P =.3) and psychiatric diagnosis (P =.24). Overall, there was only fair concordance between history and drug screens (kappa = 0.46). History alone detected substance use in 70 patients (57%); drug screening alone detected substance use in 77 patients (62%). The combination of history and drug screening more often detected substance use than either alone (90 pts (73%); P <.05 for both comparisons). Depending on the particular drug, there was wide variation in concordance between history and drug screen (kappa's varied from 0.07 for ethanol to 0.79 for cocaine). History was better than drug screening for ethanol use (40 versus 10 patients), and THC (28 versus 15 pts). Drug testing alone was never significantly better than history. Although self-reporting of substance use is not reliable, reliance on drug screening alone is also flawed. Optimal identification of drug use in emergency department psychiatric patients requires both history and drug screening. (Am J Emerg Med 2001;19:49-51. Copyright © 2001 by W.B. Saunders Company)

Section snippets

Methods

This is a prospective, cross sectional study of a convenience sample of patients who request or require psychiatric consultation presenting to the ED. This study was approved by the Committee on Studies in Human Subjects of the Hospital of the University of Pennsylvania. Patients who requested or received psychiatric consultation in our ED and in whom a urine drug screen was requested were eligible for inclusion. Our ED serves an urban indigent adult population as well as a tertiary care

Results

Two hundred eighteen patients participated; 124 had a urine drug screen obtained. Patients with and without urine drug screens were similar with respect to age (34.9 versus 34.9 years, P =.3) and psychiatric diagnosis (P =.24). There was only fair concordance between history and drug screens kappa = 0.46 (see Table 2).

. Correlation Between History of Substance Use and Toxicology Screen Results

DrugHistory+ (%)Tox Screen+ (%)Kappa Value
Cocaine37380.787
Barbiturates3.43.40.482
THC2412.80.414
Opioids8.3

Discussion

Although drug screening is widely used in ED patients to detect and document substance use, often, the patient may admit to substance use if carefully addressed in the history. Certain patients may even be seeking help for their substance use, and thus, documentation of substance use may be unnecessary. We sought to compare the results of urine drug screening with a careful patient history in ED patients who requested or required psychiatric consultation. Not surprisingly, drug screen results

References (6)

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Address reprint requests to Jeanmarie Perrone, MD, Hospital of the University of Pennsylvania, Department of Emergency Medicine, 3400 Spruce Street, Philadelphia, PA 19104. Email: [email protected]

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Am J Emerg Med 2001;19:49-51.

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0735-6757/01/1901-0013$10.00/0

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