A combined HPLC-immunoenzymatic comprehensive screening for suspected drug poisoning in the emergency department.
OBJECTIVE
To review the results of a comprehensive drug screening as first line diagnostic tool in patients attending an emergency department for suspected drug poisoning.


METHODS
A comprehensive drug screening was carried out in plasma or urine, or both, of 310 patients combining an HPLC multidrug profiling system and a fluorescence polarisation immunoassay.


RESULTS
In 64.2% of cases the screening confirmed the diagnosis of drug poisoning, in 13.9% suspected drugs were measurable at non-toxic concentrations, and in 21.9% no drugs were found. The suspected drugs were fully confirmed in a minority of cases, (symptomatic patients: 28.2% compared with asymptomatic: 16.5%). Symptomatic patients were less likely to have at least one suspected drug (29.6% compared with 57.7%; p<0.001), and more likely to have at least one unsuspected drug found at analysis (17.4% compared with 3.1%; p = 0.005). In 5% of patients, asymptomatic when first observed, one or more unsuspected drugs were found. In 6 of 29 patients, with suspected poisoning of an unspecified drug, the screening identified the specific drug and excluded acute intoxication in the remaining cases.


CONCLUSIONS
A rapid comprehensive drug screening adds to the diagnosis of patients with suspected drug poisoning, identifying unsuspected drugs in symptomatic patients and excluding drugs in asymptomatic subjects.
Fabbri
A
A
Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda Unità Sanitaria Locale di Forlì, Italy. andfabbri@libero.it <andfabbri@libero.it>
Ruggeri
S
S
Marchesini
G
G
Vandelli
A
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis / Q000652:urine; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D016231:Fluorescence Polarization Immunoassay / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000097:blood / Q000175:diagnosis / Q000652:urine