title: Comprehensive drug screening in decision making of patients attending the emergency department for suspected drug overdose.
abstract: OBJECTIVE
  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 (kappa 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda Unità Sanitaria Locale di Forl, Italy Cattedra di Malattie del Metabolismo, Università degli Studi di Bologna, Italy. andfabbri@libero.it
authors.forename: A
authors.initials: A
authors.lastname: Fabbri
authors.forename: G
authors.initials: G
authors.lastname: Marchesini
authors.forename: A M
authors.initials: AM
authors.lastname: Morselli-Labate
authors.forename: S
authors.initials: S
authors.lastname: Ruggeri
authors.forename: M
authors.initials: M
authors.lastname: Fallani
authors.forename: R
authors.initials: R
authors.lastname: Melandri
authors.forename: V
authors.initials: V
authors.lastname: Bua
authors.forename: A
authors.initials: A
authors.lastname: Pasquale
authors.forename: A
authors.initials: A
authors.lastname: Vandelli
mesh_terms: D000328:Adult; D003657:Decision Making; D062787:Drug Overdose / Q000175:diagnosis* / Q000523:psychology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008485:Medical Audit; D015588:Observer Variation; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*