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Psychiatric Patients in the Pediatric Emergency Department Undergoing Routine Urine Toxicology Screens for Medical Clearance: Results and Use

Fortu, Jesusa Milalaine T. MD, MSc*†; Kim, In K. MD; Cooper, Amy MD, MSc; Condra, Cole MD; Lorenz, Douglas J. MS; Pierce, Mary Clyde MD†§

doi: 10.1097/PEC.0b013e3181a79305
Original Articles

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.

From the *Joe DiMaggio Children's Hospital, Department of Emergency Medicine, Hollywood, FL; †Division of Pediatric Emergency Medicine, Department of Pediatrics, Kosair Children's Hospital, ‡Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY; and §Northwestern University Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL.

Reprints: Jesusa Milalaine T. Fortu, MD, Joe DiMaggio Children's Hospital, Department of Emergency Medicine, 1000 Joe DiMaggio Drive, Hollywood, FL 33021 (e-mail: jtfortumd@hotmail.com).

This study was funded by a grant from the University Pediatrics Foundation, Inc., University of Louisville, Department of Pediatrics.

© 2009 Lippincott Williams & Wilkins, Inc.