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Psychiatric patients in the pediatric emergency department undergoing routine urine toxicology screens for medical clearance: results and use.
Pediatr Emerg Care. 2009 Jun; 25(6):387-92.PE

Abstract

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.

Authors+Show Affiliations

Department of Emergency Medicine, Joe DiMaggio Children's Hospital, Hollywood, FL 33021, USA. jtfortumd@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19458561

Citation

Fortu, Jesusa Milalaine T., et al. "Psychiatric Patients in the Pediatric Emergency Department Undergoing Routine Urine Toxicology Screens for Medical Clearance: Results and Use." Pediatric Emergency Care, vol. 25, no. 6, 2009, pp. 387-92.
Fortu JM, Kim IK, Cooper A, et al. Psychiatric patients in the pediatric emergency department undergoing routine urine toxicology screens for medical clearance: results and use. Pediatr Emerg Care. 2009;25(6):387-92.
Fortu, J. M., Kim, I. K., Cooper, A., Condra, C., Lorenz, D. J., & Pierce, M. C. (2009). Psychiatric patients in the pediatric emergency department undergoing routine urine toxicology screens for medical clearance: results and use. Pediatric Emergency Care, 25(6), 387-92. https://doi.org/10.1097/PEC.0b013e3181a79305
Fortu JM, et al. Psychiatric Patients in the Pediatric Emergency Department Undergoing Routine Urine Toxicology Screens for Medical Clearance: Results and Use. Pediatr Emerg Care. 2009;25(6):387-92. PubMed PMID: 19458561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychiatric patients in the pediatric emergency department undergoing routine urine toxicology screens for medical clearance: results and use. AU - Fortu,Jesusa Milalaine T, AU - Kim,In K, AU - Cooper,Amy, AU - Condra,Cole, AU - Lorenz,Douglas J, AU - Pierce,Mary Clyde, PY - 2009/5/22/entrez PY - 2009/5/22/pubmed PY - 2009/9/3/medline SP - 387 EP - 92 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 25 IS - 6 N2 - 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. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/19458561/Psychiatric_patients_in_the_pediatric_emergency_department_undergoing_routine_urine_toxicology_screens_for_medical_clearance:_results_and_use_ L2 - http://dx.doi.org/10.1097/PEC.0b013e3181a79305 DB - PRIME DP - Unbound Medicine ER -