title: Accuracy of current clinical diagnosis in recreational drug-related attendance to the emergency department.
abstract: OBJECTIVE
  To determine the accuracy of current clinical diagnosis in recreational drug-related attendances to emergency by blood analysis.
  
  
  METHODS
  A prospective convenience sample of 103 patients who attended hospital with suspected recreational drug-related presentations was collected. Doctors' clinical impression of drugs responsible for presentation was compared with a detailed forensic blood analysis for recreational drugs.
  
  
  RESULTS
  Among 103 samples, 80 (78%, 95% confidence intervals [CI] 70-86%) were found to have correct clinical suspicion of the recreational drug responsible for clinical presentation confirmed by laboratory analysis. Clinical diagnosis was most accurate for gamma-hydroxy butyrate (GHB) (sensitivity 97%, specificity 91%) and less accurate for amphetamines (sensitivity 61%, specificity 79%), alcohol (sensitivity 42%, specificity 84%) and opiates (sensitivity 46%, specificity 100%). Multiple drug ingestion was found in 70% (95% CI 61-79%) of samples. Sensitivity and specificity of clinical impression for prediction of multiple drug ingestion presence is 75% (95% CI 66-83%) and 85% (95% CI 78-92%), respectively.
  
  
  CONCLUSIONS
  Clinical diagnosis in recreational drug-related attendances to the ED was correct in most cases. Drugs, such as GHB, were the most accurately diagnosed. Inaccuracy in recognizing other drugs, like amphetamines, opiates and alcohol, occurs where a coingestant produces a more profound clinical picture. Multiple drug ingestion is a common scenario in recreational drug presentations to emergency.
authors.affiliation: Department of Forensic Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia. westemma@hotmail.com
authors.forename: Emma
authors.initials: E
authors.lastname: West
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Reilly
authors.forename: Olaf H
authors.initials: OH
authors.lastname: Drummer
authors.forename: Adam
authors.initials: A
authors.lastname: Bystrzycki
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D019969:Amphetamine-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D001291:Attitude of Health Personnel; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects / Q000097:blood*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015813:Substance Abuse Detection / Q000379:methods / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013287:Illicit Drugs