Original ContributionsDrug screening versus history in detection of substance use in ED psychiatric patients*,**,*
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).Drug History+ (%) Tox Screen+ (%) Kappa Value Cocaine 37 38 0.787 Barbiturates 3.4 3.4 0.482 THC 24 12.8 0.414 Opioids 8.3
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)
- et al.
Therapeutic drug levels and toxicology screen
Emerg Med Clin North Am
(1986) Difficult diagnoses in toxicology: Poisons not detected by the comprehensive drug screen
Pediatr Clin North Am
(1991)- et al.
Impact of drug screening in suspected overdose
Ann Emerg Med
(1987)
Cited by (75)
Substance Use Disorder
2024, Emergency Medicine Clinics of North AmericaCannabis use the week before admission to psychiatric in-patient service as a marker of severity
2020, Journal of Psychiatric ResearchCitation Excerpt :Literature shows that self-reported substance use, including cannabis, correlates in a fairly accurate manner to positive urine toxicology tests (Fløvig et al., 2009). In fact some authors have stressed that history and scales are more reliable than drug screening for cannabis use detection (Batalla et al., 2013; Perrone et al., 2001). Furthermore, the Food and Drug Administration (FDA) and European Medicines Agency (EMA) recognize self-reporting as a tool for drug approval during clinical trials.
Medical Screening of Mental Health Patients in the Emergency Department: A Systematic Review
2018, Journal of Emergency MedicineED utilization of medical clearance testing for psychiatric admission: National Hospital Ambulatory Medical Care Survey analysis
2018, American Journal of Emergency MedicineCitation Excerpt :This recommendation was consistent with previous work showing limited utility for routine medical clearance testing for patients presenting to the emergency department (ED) with acute psychiatric illness [2,3]. Many psychiatric hospitals require screening diagnostic studies for medical clearance prior to psychiatric admission [4-6]. A better understanding of the variation in medical clearance testing for psychiatric admissions is needed to inform clinicians and policymakers about potential targets for interventions to reduce unnecessary testing and decrease healthcare costs.
A Greener Oregon: Acute Inpatient Delirium
2017, American Journal of MedicineUse of the Clinical Laboratory in Psychiatric Practice
2016, Clinics in Laboratory MedicineCitation Excerpt :Specific medications where blood levels are more useful are discussed in the class-specific sections. Although some studies have found routine drug screening to be helpful in the detection of substance use,2,3 others have found that they did not affect disposition or duration of inpatient stays,4 management,5 or diagnosis.6 There is little evidence for the usefulness of routine urine drug screening in the emergency setting for patients without clinical suspicion of substance use or intoxication.7
- *
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]
- **
Am J Emerg Med 2001;19:49-51.
- *
0735-6757/01/1901-0013$10.00/0