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http://dx.doi.org/10.22537/jksct.2022.20.1.1

Comparison of medical history based diagnosis and urine test using ultra-performance liquid chromatography-tandem mass spectrometry in drug overdose  

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)
Publication Information
Journal of The Korean Society of Clinical Toxicology / v.20, no.1, 2022 , pp. 1-7 More about this Journal
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
Diagnosis; Liquid chromatography; Medical history taking; Poisoning; Toxicology;
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Times Cited By KSCI : 2  (Citation Analysis)
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1 Kim K, Choi JW, Park M, Kim MS, Lee ES. A nationwide study of patients hospitalised for poisoning in Korea based on Korea National Hospital Discharge In-Depth Injury Survey data from 2005 to 2009. BMJ Open 2015;5:e008823.   DOI
2 Monte AA, Heard KJ, Hoppe JA, Vasiliou V, Gonzalez FJ. The accuracy of self-reported drug ingestion histories in emergency department patients. J Clin Pharmacol 2015;55:33-8.   DOI
3 Lee SK, Choi S. Availability of urine toxicologic screening tests in the emergency department: focused on illegal drugs. J Korean Soc Clin Toxicol 2021;19:24-30.   DOI
4 Yu J, Chang H, Won S, Yeom J, Lee A, Park NY, et al. Zolpidem Detection and Blood Level in Acute Poisoning-suspected Patients in Emergency Departments: Review of 229 Cases. J Korean Soc Clin Toxicol 2019;17:118-25.   DOI
5 Caglar S, Henneman PL, Blank FS, Smithline HA, Henneman EA. Emergency department medication lists are not accurate. J Emerg Med 2011;40:613-6.   DOI
6 Lee YW. Simultaneous Screening of 177 Drugs of Abuse in Urine Using Ultra-performance Liquid Chromatography with Tandem Mass Spectrometry in Drug-intoxicated Patients. Clin Psychopharmacol Neurosci 2013;11:158-64.   DOI
7 Algren DA, Christian MR. Buyer Beware: Pitfalls in Toxicology Laboratory Testing. Mo Med 2015;112:206-10.
8 Son DW, Kang JH, Kim YW, Park CH, Yoon YS, Ji JG. A satisfaction survey of toxicological laboratory: Survey of regional and local emergency medical centers. J Korean Soc Clin Toxicol 2021;19:110-26.   DOI
9 Kreshak AA, Wardi G, Tomaszewski CA. The accuracy of emergency department medication history as determined by mass spectrometry analysis of urine: a pilot study. J Emerg Med 2015; 48:382-6.   DOI
10 Bang HI, Jang MA, Lee YW. Evaluation of the Triage TOX Drug Screen Assay for Detection of 11 Drugs of Abuse and Therapeutic Drugs. Ann Lab Med 2017;37:522-5.   DOI
11 Um IK, Park JS, Han KS, Cho H, Choi SH, Lee SW, et al. Availability of Toxicologic Screening Tests in the Emergency Department. J Korean Soc Clin Toxicol 2011;9:26-9.
12 Attema-de Jonge ME, Peeters SY, Franssen EJ. Performance of three point-of-care urinalysis test devices for drugs of abuse and therapeutic drugs applied in the emergency department. J Emerg Med 2012;42:682-91.   DOI
13 Lee JS, Cha YS, Yeon S, Kim TY, Lee Y, Choi JG, et al. Changes in Diagnosis of Poisoning in Patients in the Emergency Room Using Systematic Toxicological Analysis with the National Forensic Service. J Korean Med Sci 2021;36:e118.   DOI
14 Ham S, Min YG, Chae MK, Kim HH. Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea. Clin Exp Emerg Med 2020;7:43-51.   DOI
15 Yagihashi G, Tarui T, Miyagi H, Ohnishi H, Watanabe T, Yamaguchi Y. Diagnostic accuracy for drug detection using liquid chromatography/mass spectroscopy in overdose patients. Acute Med Surg 2020;7:e487.
16 Tenenbein M. Do you really need that emergency drug screen? Clin Toxicol (Phila) 2009;47:286-91.   DOI
17 Van Wijk XMR, Goodnough R, Colby JM. Mass spectrometry in emergency toxicology: Current state and future applications. Crit Rev Clin Lab Sci 2019;56:225-38.   DOI
18 Bertol E, Vaiano F, Borsotti M, Quercioli M, Mari F. Comparison of immunoassay screening tests and LC-MS-MS for urine detection of benzodiazepines and their metabolites: results of a national proficiency test. J Anal Toxicol 2013;37:659-64.   DOI
19 Tenore PL. Advanced urine toxicology testing. J Addict Dis 2010;29:436-48.   DOI