Emergency Department Drug Surveillance (EDDS) hospital’s urinalysis results compared with expanded re-testing by an independent laboratory, a pilot study
Most hospital urine toxicology screens detect a fixed, limited set of common substances. These tests are fast and accurate but may miss emerging trends in substance use in the community and clinical acumen alone is insufficient for identifying new substances. This prospective cohort study examined d...
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| Veröffentlicht in: | Drug and alcohol dependence 2022-01, Vol.230, p.109195, Article 109195 |
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| creator | Schwartz, Brad E. Dezman, Zachary Billing, Amy S. Heine, Kimberley Massey, Ebonie Artigiani, E. Erin Motavalli, Mitra Burch, Gregory Gandhi, Priyanka Wish, Eric D. |
| description | Most hospital urine toxicology screens detect a fixed, limited set of common substances. These tests are fast and accurate but may miss emerging trends in substance use in the community and clinical acumen alone is insufficient for identifying new substances.
This prospective cohort study examined de-identified urine specimens obtained from patients visiting the Emergency Department (ED) at Prince George’s Hospital Center (PGHC), between October 15, 2019 to November 6, 2019 and tested positive for one or more substances. The Emergency Department Drug Surveillance System (EDDS) collects quarterly exports from de-identified electronic health records (EHRs) containing urinalysis results for drug related ED visits. We performed a feasibility study of a new urine specimen submission by collecting a stratified sample of 151 urine specimens from PGHC ED patients. The specimens were tested for 240 drugs using liquid chromatography-tandem mass spectrometry (LC-MS/MS). This paper presents a comparison between the PGHC and expanded testing results.
The expanded urinalysis panel found more cocaine (37% vs. 20%; p |
| doi_str_mv | 10.1016/j.drugalcdep.2021.109195 |
| format | Article |
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This prospective cohort study examined de-identified urine specimens obtained from patients visiting the Emergency Department (ED) at Prince George’s Hospital Center (PGHC), between October 15, 2019 to November 6, 2019 and tested positive for one or more substances. The Emergency Department Drug Surveillance System (EDDS) collects quarterly exports from de-identified electronic health records (EHRs) containing urinalysis results for drug related ED visits. We performed a feasibility study of a new urine specimen submission by collecting a stratified sample of 151 urine specimens from PGHC ED patients. The specimens were tested for 240 drugs using liquid chromatography-tandem mass spectrometry (LC-MS/MS). This paper presents a comparison between the PGHC and expanded testing results.
The expanded urinalysis panel found more cocaine (37% vs. 20%; p < 0.01) and benzodiazepine positives (21% vs. 11%; p < 0.05) than would have been detected by the hospital screen. Additionally, the expanded toxicology panel identified fentanyl in 4–14% of the samples.
The EHR data submitted to EDDS from the hospital urine toxicology screen correctly identified hospital substance use patterns over the approximate 1 month study period. The expanded testing also uncovered drugs that the hospital might consider adding to their routine screen. EDDS is a feasible system for monitoring and confirming recent substance use trends among ED patients
•Why is this topic important?Standard hospital urine toxicology screens can miss critical changes of substance use in emergency department (ED) patients.Most urine toxicology screens used by hospitals do not detect many synthetically derived substances.•What does this study attempt to show?This pilot supports the use of the Emergency Department Drug Surveillance (EDDS) database.EDDS is a centralized database to monitor substance use trends via the hospital urine toxicology ED reports.EDDS can largely identify and reflect drug use patterns amongst patient presenting to the emergency department.With EDDS clinicians caring for patients in the ED can better identify patients suffering from SUD and target interventions.•What are the key findings?The expanded analysis of de-identified urine specimens accurately corroborated with EDDS.This study is unique in methodology, utilizing LC-MS/MS to confirm KIMS based urine toxicology testing from ED samples.•How is patient care impacted?This pilot study supported the current urine toxicology profile being performed in the clinical research site’s ED.Based on substance use trends in their clinical setting, hospitals can retain or modify their urine toxicology testing.</description><identifier>ISSN: 0376-8716</identifier><identifier>EISSN: 1879-0046</identifier><identifier>DOI: 10.1016/j.drugalcdep.2021.109195</identifier><identifier>PMID: 34871979</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Benzodiazepines ; Chromatography, Liquid ; Cocaine ; Cohort analysis ; Computerized medical records ; Diagnostic tests ; Drug surveillance ; Drug use ; Drugs ; Electronic health records ; Electronic medical records ; Emergency medical care ; Emergency medical services ; Emergency medicine ; Emergency Service, Hospital ; Emergency services ; Exports ; Feasibility ; Feasibility studies ; Fentanyl ; Health records ; Hospitals ; Humans ; Laboratories ; Liquid chromatography ; Mass spectrometry ; Mass spectroscopy ; Patients ; Pharmaceutical Preparations ; Pilot Projects ; Prospective Studies ; Spectrometry ; Substance abuse ; Substance use ; Surveillance ; Surveillance systems ; Tandem Mass Spectrometry ; Testing ; Toxicology ; Trends ; Urinalysis ; Urine ; Urine tests</subject><ispartof>Drug and alcohol dependence, 2022-01, Vol.230, p.109195, Article 109195</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Jan 1, 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-479640826b445e25475f4ee59e1c83cdb183f7c0477129f570dbeb5cdab975323</citedby><cites>FETCH-LOGICAL-c402t-479640826b445e25475f4ee59e1c83cdb183f7c0477129f570dbeb5cdab975323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0376871621006906$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,30976,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34871979$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schwartz, Brad E.</creatorcontrib><creatorcontrib>Dezman, Zachary</creatorcontrib><creatorcontrib>Billing, Amy S.</creatorcontrib><creatorcontrib>Heine, Kimberley</creatorcontrib><creatorcontrib>Massey, Ebonie</creatorcontrib><creatorcontrib>Artigiani, E. Erin</creatorcontrib><creatorcontrib>Motavalli, Mitra</creatorcontrib><creatorcontrib>Burch, Gregory</creatorcontrib><creatorcontrib>Gandhi, Priyanka</creatorcontrib><creatorcontrib>Wish, Eric D.</creatorcontrib><title>Emergency Department Drug Surveillance (EDDS) hospital’s urinalysis results compared with expanded re-testing by an independent laboratory, a pilot study</title><title>Drug and alcohol dependence</title><addtitle>Drug Alcohol Depend</addtitle><description>Most hospital urine toxicology screens detect a fixed, limited set of common substances. These tests are fast and accurate but may miss emerging trends in substance use in the community and clinical acumen alone is insufficient for identifying new substances.
This prospective cohort study examined de-identified urine specimens obtained from patients visiting the Emergency Department (ED) at Prince George’s Hospital Center (PGHC), between October 15, 2019 to November 6, 2019 and tested positive for one or more substances. The Emergency Department Drug Surveillance System (EDDS) collects quarterly exports from de-identified electronic health records (EHRs) containing urinalysis results for drug related ED visits. We performed a feasibility study of a new urine specimen submission by collecting a stratified sample of 151 urine specimens from PGHC ED patients. The specimens were tested for 240 drugs using liquid chromatography-tandem mass spectrometry (LC-MS/MS). This paper presents a comparison between the PGHC and expanded testing results.
The expanded urinalysis panel found more cocaine (37% vs. 20%; p < 0.01) and benzodiazepine positives (21% vs. 11%; p < 0.05) than would have been detected by the hospital screen. Additionally, the expanded toxicology panel identified fentanyl in 4–14% of the samples.
The EHR data submitted to EDDS from the hospital urine toxicology screen correctly identified hospital substance use patterns over the approximate 1 month study period. The expanded testing also uncovered drugs that the hospital might consider adding to their routine screen. EDDS is a feasible system for monitoring and confirming recent substance use trends among ED patients
•Why is this topic important?Standard hospital urine toxicology screens can miss critical changes of substance use in emergency department (ED) patients.Most urine toxicology screens used by hospitals do not detect many synthetically derived substances.•What does this study attempt to show?This pilot supports the use of the Emergency Department Drug Surveillance (EDDS) database.EDDS is a centralized database to monitor substance use trends via the hospital urine toxicology ED reports.EDDS can largely identify and reflect drug use patterns amongst patient presenting to the emergency department.With EDDS clinicians caring for patients in the ED can better identify patients suffering from SUD and target interventions.•What are the key findings?The expanded analysis of de-identified urine specimens accurately corroborated with EDDS.This study is unique in methodology, utilizing LC-MS/MS to confirm KIMS based urine toxicology testing from ED samples.•How is patient care impacted?This pilot study supported the current urine toxicology profile being performed in the clinical research site’s ED.Based on substance use trends in their clinical setting, hospitals can retain or modify their urine toxicology testing.</description><subject>Benzodiazepines</subject><subject>Chromatography, Liquid</subject><subject>Cocaine</subject><subject>Cohort analysis</subject><subject>Computerized medical records</subject><subject>Diagnostic tests</subject><subject>Drug surveillance</subject><subject>Drug use</subject><subject>Drugs</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency medicine</subject><subject>Emergency Service, Hospital</subject><subject>Emergency services</subject><subject>Exports</subject><subject>Feasibility</subject><subject>Feasibility studies</subject><subject>Fentanyl</subject><subject>Health records</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Liquid chromatography</subject><subject>Mass spectrometry</subject><subject>Mass spectroscopy</subject><subject>Patients</subject><subject>Pharmaceutical Preparations</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Spectrometry</subject><subject>Substance abuse</subject><subject>Substance use</subject><subject>Surveillance</subject><subject>Surveillance systems</subject><subject>Tandem Mass Spectrometry</subject><subject>Testing</subject><subject>Toxicology</subject><subject>Trends</subject><subject>Urinalysis</subject><subject>Urine</subject><subject>Urine tests</subject><issn>0376-8716</issn><issn>1879-0046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkc2OFCEUhYnROO3oKxgSN5pYLVAUFEudbn-SSVyMrgkFt3roVBUlUKO18zWMb-eTyKRHXcoCcm_OPYebDyFMyZYSKl4dty4uBzNYB_OWEUZLW1HV3EMb2kpVEcLFfbQhtRRVK6k4Q49SOpJyhCIP0VnNS1dJtUE_9yPEA0x2xTuYTcwjTBnviju-WuIN-GEwkwX8fL_bXb3A1yHNPpvh1_cfCS_RT2ZYk084QlqGnLANYzEBh7_6fI3h22wmV6oIVYaU_XTA3YrNhH1pz1CuEjaYLkSTQ1xfYoNnP4SMU17c-hg96M2Q4Mnde44-v91_unhfXX589-Hi9WVlOWG54lIJTlomOs4bYA2XTc8BGgXUtrV1HW3rXlrCpaRM9Y0kroOusc50SjY1q8_Rs5PvHMOXpfxTH8MSy2pJM8FkK4hsRFG1J5WNIaUIvZ6jH01cNSX6loo-6n9U9C0VfaJSRp_eBSzdCO7v4B8MRfDmJICy5o2HqJP1BQo4H8Fm7YL_f8pvMCamlQ</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Schwartz, Brad E.</creator><creator>Dezman, Zachary</creator><creator>Billing, Amy S.</creator><creator>Heine, Kimberley</creator><creator>Massey, Ebonie</creator><creator>Artigiani, E. Erin</creator><creator>Motavalli, Mitra</creator><creator>Burch, Gregory</creator><creator>Gandhi, Priyanka</creator><creator>Wish, Eric D.</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20220101</creationdate><title>Emergency Department Drug Surveillance (EDDS) hospital’s urinalysis results compared with expanded re-testing by an independent laboratory, a pilot study</title><author>Schwartz, Brad E. ; Dezman, Zachary ; Billing, Amy S. ; Heine, Kimberley ; Massey, Ebonie ; Artigiani, E. 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Erin</creatorcontrib><creatorcontrib>Motavalli, Mitra</creatorcontrib><creatorcontrib>Burch, Gregory</creatorcontrib><creatorcontrib>Gandhi, Priyanka</creatorcontrib><creatorcontrib>Wish, Eric D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Drug and alcohol dependence</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schwartz, Brad E.</au><au>Dezman, Zachary</au><au>Billing, Amy S.</au><au>Heine, Kimberley</au><au>Massey, Ebonie</au><au>Artigiani, E. Erin</au><au>Motavalli, Mitra</au><au>Burch, Gregory</au><au>Gandhi, Priyanka</au><au>Wish, Eric D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency Department Drug Surveillance (EDDS) hospital’s urinalysis results compared with expanded re-testing by an independent laboratory, a pilot study</atitle><jtitle>Drug and alcohol dependence</jtitle><addtitle>Drug Alcohol Depend</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>230</volume><spage>109195</spage><pages>109195-</pages><artnum>109195</artnum><issn>0376-8716</issn><eissn>1879-0046</eissn><abstract>Most hospital urine toxicology screens detect a fixed, limited set of common substances. These tests are fast and accurate but may miss emerging trends in substance use in the community and clinical acumen alone is insufficient for identifying new substances.
This prospective cohort study examined de-identified urine specimens obtained from patients visiting the Emergency Department (ED) at Prince George’s Hospital Center (PGHC), between October 15, 2019 to November 6, 2019 and tested positive for one or more substances. The Emergency Department Drug Surveillance System (EDDS) collects quarterly exports from de-identified electronic health records (EHRs) containing urinalysis results for drug related ED visits. We performed a feasibility study of a new urine specimen submission by collecting a stratified sample of 151 urine specimens from PGHC ED patients. The specimens were tested for 240 drugs using liquid chromatography-tandem mass spectrometry (LC-MS/MS). This paper presents a comparison between the PGHC and expanded testing results.
The expanded urinalysis panel found more cocaine (37% vs. 20%; p < 0.01) and benzodiazepine positives (21% vs. 11%; p < 0.05) than would have been detected by the hospital screen. Additionally, the expanded toxicology panel identified fentanyl in 4–14% of the samples.
The EHR data submitted to EDDS from the hospital urine toxicology screen correctly identified hospital substance use patterns over the approximate 1 month study period. The expanded testing also uncovered drugs that the hospital might consider adding to their routine screen. EDDS is a feasible system for monitoring and confirming recent substance use trends among ED patients
•Why is this topic important?Standard hospital urine toxicology screens can miss critical changes of substance use in emergency department (ED) patients.Most urine toxicology screens used by hospitals do not detect many synthetically derived substances.•What does this study attempt to show?This pilot supports the use of the Emergency Department Drug Surveillance (EDDS) database.EDDS is a centralized database to monitor substance use trends via the hospital urine toxicology ED reports.EDDS can largely identify and reflect drug use patterns amongst patient presenting to the emergency department.With EDDS clinicians caring for patients in the ED can better identify patients suffering from SUD and target interventions.•What are the key findings?The expanded analysis of de-identified urine specimens accurately corroborated with EDDS.This study is unique in methodology, utilizing LC-MS/MS to confirm KIMS based urine toxicology testing from ED samples.•How is patient care impacted?This pilot study supported the current urine toxicology profile being performed in the clinical research site’s ED.Based on substance use trends in their clinical setting, hospitals can retain or modify their urine toxicology testing.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>34871979</pmid><doi>10.1016/j.drugalcdep.2021.109195</doi></addata></record> |
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| ispartof | Drug and alcohol dependence, 2022-01, Vol.230, p.109195, Article 109195 |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Benzodiazepines Chromatography, Liquid Cocaine Cohort analysis Computerized medical records Diagnostic tests Drug surveillance Drug use Drugs Electronic health records Electronic medical records Emergency medical care Emergency medical services Emergency medicine Emergency Service, Hospital Emergency services Exports Feasibility Feasibility studies Fentanyl Health records Hospitals Humans Laboratories Liquid chromatography Mass spectrometry Mass spectroscopy Patients Pharmaceutical Preparations Pilot Projects Prospective Studies Spectrometry Substance abuse Substance use Surveillance Surveillance systems Tandem Mass Spectrometry Testing Toxicology Trends Urinalysis Urine Urine tests |
| title | Emergency Department Drug Surveillance (EDDS) hospital’s urinalysis results compared with expanded re-testing by an independent laboratory, a pilot study |
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