Psychiatric patients in the pediatric emergency department undergoing routine urine toxicology screens for medical clearance: results and use.
OBJECTIVE
We sought to determine the use and results of urine toxicology screens (UTS) in psychiatric patients undergoing a UTS test for medical clearance in a pediatric emergency department.


METHODS
A structured retrospective study was conducted over a 6-month period. All emergency department (ED) charts were reviewed of patients 8 to 17 years who had a UTS. Urine toxicology screens were identified as medically indicated or routine-driven. Medically indicated UTS were patients who presented with seizures, syncope, headache, altered mental status, ingestion, chest pain/palpitation, shortness of breath, sexual assault, or those who were brought in for motor vehicle accident (MVA). Routine-driven UTS were uncomplicated psychiatric patients who presented with aggressive or out of control behavior, intentional self-inflicted wounds, or symptoms of depression, all of whom presented without any evidence of drug or alcohol ingestion or altered mental status. Routine-driven UTS were quantified for positive tests. In addition, we determined the change in management and disposition of those patients. We also determined the concordance of provided drug use history with UTS result.


RESULTS
Of the 652 charts reviewed, 267 UTS were medically indicated; 385 were routine-driven. Of the routine-driven UTS group, 254/267 (95%) patients with negative screens and 115/118 (97%) with positive screens were referred for psychiatric treatment after psychiatric evaluation. Fisher exact test of the comparison of the disposition after psychiatric assessment with the UTS result was nonsignificant. The UTS result also had no effect on the type of psychiatric disposition (ie, outpatient therapy, partial hospitalization, inpatient hospitalization). Concordance with provided history of illicit drug use was significant.


CONCLUSIONS
Routine-driven UTS in uncomplicated pediatric psychiatric patients being evaluated in the ED offered little additional information, did not influence management, and potentially increased both ED cost and time. Patients with straightforward psychiatric complaints may be medically cleared without a UTS.
Fortu
Jesusa Milalaine T
JM
Department of Emergency Medicine, Joe DiMaggio Children's Hospital, Hollywood, FL 33021, USA. jtfortumd@hotmail.com
Kim
In K
IK
Cooper
Amy
A
Condra
Cole
C
Lorenz
Douglas J
DJ
Pierce
Mary Clyde
MC
D000063:Accidents, Traffic; D000293:Adolescent; D002648:Child; D015897:Comorbidity; D008192:Deception; D003953:Diagnosis-Related Groups; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D013287:Illicit Drugs / Q000652:urine*; D008297:Male; D001523:Mental Disorders / Q000652:urine; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D009422:Nervous System Diseases / Q000652:urine; D015588:Observer Variation; D012008:Recurrence; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000652:urine; D012742:Sex Offenses; D015813:Substance Abuse Detection / Q000379:methods / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000652:urine*; D016482:Urinalysis / Q000706:statistics & numerical data*
D013287:Illicit Drugs