title: Urine toxicology screening in an urban stroke and TIA population.
abstract: OBJECTIVE
  We sought to determine the rate of urine toxicology screening, differences in testing, and outcomes among patients with stroke and TIA presenting to a tertiary care emergency department.
  
  
  METHODS
  In this retrospective cohort study, patients admitted with stroke or TIA to a single tertiary care stroke center between June 2005 and January 2007 were identified through a stroke database. Factors that predicted urine toxicology screening of patients and a positive test, and discharge outcomes of patients based on toxicology result were analyzed. Stroke severity, treatment with tissue plasminogen activator, discharge status, and stroke etiology were compared between toxicology positive and negative patients.
  
  
  RESULTS
  A total of 1,024 patients were identified: 704 with ischemic stroke, 133 with intracerebral hemorrhage, and 205 with TIA. Urine toxicology screening was performed in 420 patients (40%); 11% of these studies were positive for cocaine (19% younger than 50 years and 9% 50 years or older). Factors that significantly predicted the performance of a urine toxicology screen were younger age (<50 years) and black race (<0.001). Positive toxicology screens occurred in a broad range of patients. There were no significant differences in admission NIH Stroke Scale score, stroke etiology, and discharge status between toxicology-positive and -negative patients.
  
  
  CONCLUSIONS
  In this study, patients with stroke and TIA who were young and black were more likely to have urine toxicology screening. Eleven percent of all tested patients (and 9% of patients 50 years or older) were positive for cocaine. To avoid disparities, we suggest that all stroke and TIA patients be tested.
authors.affiliation: Department of Neurology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA. bsilver@lifespan.org
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
authors.forename: Daniel
authors.initials: D
authors.lastname: Miller
authors.forename: Michelle
authors.initials: M
authors.lastname: Jankowski
authors.forename: Nawaf
authors.initials: N
authors.lastname: Murshed
authors.forename: Patricia
authors.initials: P
authors.lastname: Garcia
authors.forename: Patricia
authors.initials: P
authors.lastname: Penstone
authors.forename: Melissa
authors.initials: M
authors.lastname: Straub
authors.forename: Sean P
authors.initials: SP
authors.lastname: Logan
authors.forename: Anita
authors.initials: A
authors.lastname: Sinha
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Morris
authors.forename: Angelos
authors.initials: A
authors.lastname: Katramados
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Russman
authors.forename: Panayiotis D
authors.initials: PD
authors.lastname: Mitsias
authors.forename: Lonni R
authors.initials: LR
authors.lastname: Schultz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D019970:Cocaine-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000652:urine*; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000209:etiology / Q000652:urine*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000652:urine*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D044465:White People
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator