Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Comparison of medical history based diagnosis and urine test using ultra-performance liquid chromatography-tandem mass spectrometry in drug overdose

약물중독 환자에서 병력 기반 진단과 요 고성능 액체색층분석 탄뎀 질량 분광분석의 비교

  • Lee, Ja-Young (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cha, Kyungman (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Won Jung (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyung Min (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • So, Byung Hak (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • 이자영 (가톨릭대학교 의과대학 성빈센트병원 응급의학과) ;
  • 차경만 (가톨릭대학교 의과대학 성빈센트병원 응급의학과) ;
  • 정원중 (가톨릭대학교 의과대학 성빈센트병원 응급의학과) ;
  • 김형민 (가톨릭대학교 의과대학 성빈센트병원 응급의학과) ;
  • 소병학 (가톨릭대학교 의과대학 성빈센트병원 응급의학과)
  • Received : 2022.02.10
  • Accepted : 2022.05.02
  • Published : 2022.06.30
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Abstract

Purpose: In patients with acute drug overdose, identification of drugs ingested is crucial to make a precise diagnosis. In most cases, the diagnoses are made on the medical history and physical examination findings. This study was undertaken to determine the concordance of diagnosis made on the basis of patient history by comparing it with urine toxicology analysis. Methods: This was a retrospective study of drug intoxicated patients over 18 years old who presented to the emergency center from 2017 to 2019. Specimens from urine were tested using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-TMS). The test results were compared with information obtained from patients. Diagnostic concordances for drug detection in intoxicated patients were calculated. Logistic regression analysis was used to examine the association between clinical characteristics and diagnostic discrepancy. Results: Totally, 370 patients were included in the analysis. Overall, 66 types of drugs were detected by UPLC-TMS. The drugs detected most frequently were zolpidem (104, 27.8%), citalopram (70, 18.7%), and paracetamol (66, 17.6%). The mean diagnostic concordance of patients was 52.7%. There were statistically significant diagnostic discrepancies in patients with underlying depression and patients intoxicated with multiple types of drugs. Conclusion: In ED patients with acute drug overdose, the diagnoses made on history alone were often inaccurate. It is essential to perform urine toxicology tests such as UPLC-TMS as a confirmatory instrument to improve accuracy in evaluating patients with drug intoxication.

Keywords

References

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