The Urine Drug Screen in the Emergency Department

2022 ◽  
Vol 2 (1) ◽  
pp. 0-0
Keyword(s):  
Emergency Department ◽  
Informed Consent ◽  
Altered Mental Status ◽  
Urine Drug Screen ◽  
Screening Process ◽  
Clinical Vignettes ◽  
Opt Out ◽  
Urine Drug ◽  
Consent To Treatment ◽  
The Impact

Urine drug screens (UDSs) are often performed in the emergency department (ED) as part of a standard ED order set in patients with significant altered mental status, trauma, or seizures usually without the patient’s knowledge or specified informed consent. In the ED the UDS has been included in the standard consent to treatment for routine testing along with blood studies, EKG, urinalysis and radiology. Many technical factors are known to effect UDS results.There is a lack of education among physicians regarding the clinical pitfalls of UDS interpretation. This article discusses the current state and issues associated with the UDS, and presents three clinical vignettes that illustrate the impact of false-positive UDS results on patient care and the potential for a patient becoming unknowingly and unfairly stigmatized. The article also offers suggestions including a requirement for either formal informed consent or an “opt out” screening process, as recommended by the CDC in HIV testing, designed to protect patient autonomy and confidentiality.

The Urine Drug Screen in the Emergency Department

2022 ◽  
Vol 2 (1) ◽  
pp. 0-0
Keyword(s):  
Emergency Department ◽  
Informed Consent ◽  
Altered Mental Status ◽  
Urine Drug Screen ◽  
Screening Process ◽  
Clinical Vignettes ◽  
Opt Out ◽  
Urine Drug ◽  
Consent To Treatment ◽  
The Impact

Urine drug screens (UDSs) are often performed in the emergency department (ED) as part of a standard ED order set in patients with significant altered mental status, trauma, or seizures usually without the patient’s knowledge or specified informed consent. In the ED the UDS has been included in the standard consent to treatment for routine testing along with blood studies, EKG, urinalysis and radiology. Many technical factors are known to effect UDS results.There is a lack of education among physicians regarding the clinical pitfalls of UDS interpretation. This article discusses the current state and issues associated with the UDS, and presents three clinical vignettes that illustrate the impact of false-positive UDS results on patient care and the potential for a patient becoming unknowingly and unfairly stigmatized. The article also offers suggestions including a requirement for either formal informed consent or an “opt out” screening process, as recommended by the CDC in HIV testing, designed to protect patient autonomy and confidentiality.

scholarly journals 845. Impact of the COVID-19 Pandemic on Routine HIV Screening in an Emergency Department

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S513-S513
Author(s):  
Elizabeth A Aguilera ◽  
Gilhen Rodriguez ◽  
Gabriela P Del Bianco ◽  
Gloria Heresi ◽  
James Murphy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Program ◽  
Medical Center ◽  
Hiv Infections ◽  
Hiv Screening ◽  
Opt Out ◽  
Number Of Patients ◽  
Confirmatory Tests ◽  
Routine Hiv Screening ◽  
The Impact

Abstract Background The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC), Houston, Texas has a long established screening program targeted at detection of HIV infections. The impact of the COVID-19 pandemic on this screening program is unknown. Methods The Routine HIV screening program includes opt-out testing of all adults 18 years and older with Glasgow score > 9. HIV 4th generation Ag/Ab screening, with reflex to Gennius confirmatory tests are used. Pre-pandemic (March 2019 to February 2020) to Pandemic period (March 2020 to February 2021) intervals were compared. Results 72,929 patients visited MHH_ED during the pre-pandemic period and 57,128 in the pandemic period, a 22% decline. The number of patients tested for HIV pre-pandemic was 9433 and 6718 pandemic, a 29% decline. When the pandemic year was parsed into first and last 6 months interval and compared to similar intervals in the year pre pandemic, 39% followed by 16% declines in HIV testing were found. In total, 354 patients were HIV positives, 209, (59%) in the pre-pandemic and 145 (41%) in the pandemic period.The reduction in new HIV infections found was directly proportional to the decline in patients visiting the MHH-ED where the percent of patients HIV positive was constant across intervals (2.21% vs 2.26%). Demographic and outcome characteristics were constant across the compared intervals. Conclusion The COVID -19 pandemic reduced detection of new HIV infections by screening in direct proportion to the reduction in MHH-ED patient visits. The impact of COVID-19 pandemic decreased with duration of the pandemic. Disclosures All Authors: No reported disclosures

scholarly journals A Case of Levamisole-Induced Agranulocytosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Thamer Kassim ◽  
Lakshmi Chintalacheruvu ◽  
Osman Bhatty ◽  
Mohammad Selim ◽  
Osama Diab ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Cell ◽  
Maximum Temperature ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Past Medical History ◽  
Urine Drug ◽  
History Of ◽  
Quick Turnaround ◽  
Wbc Count

A sixty-eight-year-old male with a past medical history of recurrent cocaine use presented to the emergency department with recurrent diarrhea and was found to have a white blood cell (WBC) count of 1.9 × 109/L with agranulocytosis (absolute neutrophil count (ANC) of 95 cell/mm3). At admission, the patient disclosed that he used cocaine earlier during the day, and a urine drug screen tested positive for this. On hospital day one, the patient was found to have a fever with a maximum temperature of 313.6 K. After ruling out other causes and noting the quick turnaround of his neutropenia after four days of cocaine abstinence, the patient’s neutropenia was attributed to levamisole-adulterated cocaine.

scholarly journals Urine drug screen trends from 1998 through 2011 among emergency department patients treated in a University Teaching Hospital

2018 ◽  
Vol 2 (1) ◽  
pp. 24-34
Author(s):  
Nadejda Korneeva ◽  
Urska Cvek ◽  
Anna Leskova ◽  
Kimberley Hutchinson ◽  
Avery Callahan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
University Teaching ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Urine Drug ◽  
Emergency Department Patients

CSF studies which ultimately led to the possible diagnosis of anti-NMDAR encephalitis

2020 ◽  
Vol 13 (5) ◽  
pp. e233489
Author(s):  
Caroline Roberts ◽  
Morgan McEachern ◽  
Anne Mounsey
Keyword(s):  
Mental Status ◽  
Autoimmune Encephalitis ◽  
Altered Mental Status ◽  
Good Prognosis ◽  
Urine Drug Screen ◽  
Autonomic Dysregulation ◽  
Urine Drug ◽  
Blood Pressures ◽  
Electroencephalogram Eeg ◽  
New Onset

A 17-year-old man with no significant medical history presented with new-onset seizure activity and altered mental status manifesting as bizarre behaviour, which included rapid pressured and tangential speech, psychomotor agitation, insomnia and delusions. He also had autonomic dysregulation, manifested in labile blood pressures. He had been recently discharged from his first psychiatric hospitalisation. Many studies were performed, including electroencephalogram (EEG), head CT, laboratory work, urine drug screen and lumbar puncture with cerebral spinal fluid studies, which ultimately led to the diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) autoimmune encephalitis. He was treated with five rounds of plasmapheresis with complete resolution of his altered mental status. This case highlights the importance of being familiar with the presentation of anti-NMDAR autoimmune encephalitis, especially in cases of new-onset mental status changes with psychotic like symptoms, seizure-like activity and autonomic dysregulation as early detection and treatment improves chances of good prognosis with return to baseline cognitive function.

scholarly journals 968. The Impact of Opt-Out HIV Screening and Patient Navigator-Assisted Linkage to Care of Newly Diagnosed Persons with HIV in a High-Prevalence Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S513-S514
Author(s):  
Swetha Kodali ◽  
Jeffrey M Paer ◽  
Alexander W Sudyn ◽  
Samuel Maldonado ◽  
Amesika Nyaku ◽  
...  
Keyword(s):  
Emergency Department ◽  
New Jersey ◽  
Linkage To Care ◽  
Safety Net ◽  
Patient Navigator ◽  
Hiv Screening ◽  
Newly Diagnosed ◽  
Heterosexual Contact ◽  
Opt Out ◽  
The Impact

Abstract Background Newark is the epicenter of the HIV epidemic in New Jersey. University Hospital, the state’s only public safety net hospital, plays a critical role in identifying and linking newly diagnosed persons with HIV (PWH) to care. We previously showed that the emergency department (ED) is the most common setting for missed testing opportunities. Therefore, in 2015 we implemented a routine opt-out HIV screening and patient navigator (PN)-assisted linkage to care (LTC) protocol in the ED, and this project examined the LTC rates for newly diagnosed PWH. Methods We conducted an IRB-approved retrospective chart review of patients who tested positive for HIV in the ED between 2015 and 2018. Descriptive statistics were used to summarize demographic and clinical data. Univariate and multivariate regression were used to identify demographic and clinical factors associated with LTC for newly diagnosed PWH. Age, sex, and factors with p ≤ 0.10 in the univariate analysis were included in the final model. Results Of the 464 patients who screened positive, 123 (26.5%) were new diagnoses. The mean age was 41.0 years (SD = 13.8); 82 (67%) male; 74 (60%) black, 26 (21%) Hispanic, 7 (6%) white. The median CD4 count was 242 (IQR = 120 - 478) cells/µL, and 10 patients (8.1%) had acute HIV infection. Six patients (4.9%) died before LTC. Among the remaining 117 patients, PN outreach resulted in scheduled appointments at the Infectious Disease Practice for 102 (87.2%). In total, 79 (67.5%) were linked to care and 38 (32.5%) were referred to the state for linkage. Of the patients linked to care, 49 (62.0%) attended their first appointment and 30 (38.0%) required additional PN outreach. Men who have sex with men (MSM) (OR = 17.2, p = 0.002) and heterosexual contact (OR = 6.3, p < 0.001) were predictive of LTC. Conclusion Our protocol resulted in LTC for the majority of newly diagnosed PWH. Among those linked to care, over a third required additional PN outreach after missing their first appointment, highlighting the importance of PN follow-up. MSM and heterosexual contact, the two highest risk factors for HIV in New Jersey, were predictive of LTC. Their successful LTC may be explained, in part, by the fact that PNs were demographically similar and lessened perceived stigma associated with entry into care. Disclosures All Authors: No reported disclosures

Reduced Interference by Phenothiazines in Amphetamine Drug of Abuse Immunoassays

2006 ◽  
Vol 130 (12) ◽  
pp. 1834-1838
Author(s):  
Stacy E. F. Melanson ◽  
Elizabeth Lee-Lewandrowski ◽  
David A. Griggs ◽  
William H. Long ◽  
James G. Flood
Keyword(s):  
Emergency Department ◽  
False Positive ◽  
Massachusetts General Hospital ◽  
Parent Compound ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Drug Of Abuse ◽  
Positive Urine ◽  
Urine Drug ◽  
Positive Results

Abstract Context.—Emergency department physicians frequently request urine drug screens, but many are unaware of their limitations, including the potential for false-positive results. Promethazine, a phenothiazine derivative, is used for the treatment of allergies, agitation, nausea, and vomiting. Many patients taking promethazine are subject to urine drug screens and any potential interferences are important to recognize. Design.—During an 11-month period, all patients presenting to the Massachusetts General Hospital emergency department who had a finding of promethazine in their serum drug screen, and who also had a urine drug screen performed, were selected for inclusion in the study. The urine drug screen results (n = 22 patients/samples) were then studied. Objective.—To determine if promethazine use can cause false-positive urine amphetamine results in widely used drug of abuse immunoassays. Results.—Thirty-six percent of patients taking promethazine had false-positive test results for urine amphetamines using the EMIT II Plus Monoclonal Amphetamine/Methamphetamine Immunoassay. Sixty-four percent of patients showed cross-reactivity greater than 20% higher than the blank calibrator rate. In a separate, related study, no promethazine-induced false-positive results were seen with the EMIT II Plus, Triage, and TesTcard 9 amphetamine assays, or the Triage methamphetamine assay. Reduced chlorpromazine interference was also seen with these other assays. Conclusions.—False-positive urine amphetamine results can be obtained in patients taking promethazine. Promethazine metabolite(s), and not the parent compound, are the likely cause of these urine false-positive results obtained with EMIT II Plus Monoclonal Amphetamine/Methamphetamine Immunoassay. Immunoassays from different manufacturers can have very different “interference” profiles, which the pathologist and laboratory scientist must understand and relay to clinicians.

scholarly journals 47. Impact of COVID-19 Pandemic on an Emergency Department Opt-out HIV Screening Program: An Interrupted Time Series Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S33-S34
Author(s):  
Jianli Niu ◽  
Paula Eckardt
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Hiv Testing ◽  
Interrupted Time Series ◽  
South Florida ◽  
Health Concern ◽  
Public Healthcare ◽  
Opt Out ◽  
Hiv Test ◽  
The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has posed tremendous challenges to health care systems, including emergency department (ED) priorities and visits. We describe the impact of COVID-19 pandemic on ED-based “Opt-out” HIV testing at a public healthcare system in South Florida. Methods The programmatic data of ED-based HIV testing from July 2018 to March 2021 at the Memorial Regional Hospital, Hollywood, Florida was retrospectively analyzed. Interrupted time series (ITS) analysis models were developed to evaluate the immediate and gradual effects of the pandemic on the monthly number of HIV tests over time, with an interruption point at March 2020. Results 45,185 HIV tests were recorded between July 2018 and March 2021. A mean of 1,745 (SD, 266) HIV tests per month before the COVID-19 pandemic (July 2018 to Feb 2020) and a mean of 791 (SD, 187) HIV tests per month during the pandemic period (March 2020 to March 2021) was seen (p< 0.0001). As shown in Table 1, there was a slight decline trend in the number of monthly HIV test before the pandemic (estimate -10.29, p=0.541). We estimated a significant decrease in monthly HIV tests (estimate -678.48, p = 0.008), whereas the slope change after the pandemic was non-significant (estimate 4.84, p = 0.891). The number of monthly HIV tests declined significantly during the early phase of the pandemic, particularly between March 2020 and September 2020 (all p< 0.05), with an estimated 48.0% decrease in the March 2020 (estimate -678.48, p = 0.007), 43% in the April 2020 (estimate -673.65, p=0.007), and 50.7% in the May 2020 (estimate -668.83, p=0.009), compared with the same month of the pre-pandemic period (Figure 1). This decline in number of monthly HIV tests is consistent with the first wave of the COVID-19 pandemic in South Florida. Number of decreased monthly HIV tests from October 2020 through March 2021 was less pronounced (all p >0.05) and returned to pre-pandemic levels. Conclusion The COVID-19 pandemic led to a significant and immediate decline in monthly number of ED-based HIV tests. Disruption of basic health services by the COVID-19 pandemic is a public health concern. Strategies to develop an infrastructure to meet the demands of HIV testing should be implemented to ensure the current HIV prevention during the COVID-19 period. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document