We discuss the (F)utility(?) of ED Utox screens with our very own Dr. Phil DiSalvo.
Hosts:
Bree Tse, MD
Brian Gilberti, MD
Core EM - Emergency Medicine Podcast Episode 180.0: Urine Tox Screens
Jan 12, 2021
Dr. Philip DiSalvo, an emergency physician and toxicologist, discusses the reliability and limitations of urine drug screens in emergency medicine. Topics include false positives/negatives, interference, and the need for additional testing methods. The impact of timing and drug detection duration is explored, along with the role of urine drug screens in ED management and psychiatry.
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UDS Origins
- Urine drug screens (UDS) originated from government testing of Vietnam War vets and federal employees.
- The NIDA-5 drugs (marijuana, PCP, opiates, amphetamines, cocaine) form the basis of most UDS panels.
Misleading UDS Results
- A patient with opioid and cocaine intoxication had a UDS positive only for cocaine, missing the opioids.
- Further analysis revealed numerous other substances, highlighting that UDS results can be misleading.
When to Use Quantitative UDS
- Use quantitative UDS in drug-facilitated sexual assault and child abuse cases.
- Confirmatory tests like GC/MS or LC/MS are crucial for legal and diagnostic accuracy.
