약물중독 환자에서 병력 기반 진단과 요 고성능 액체색층분석 탄뎀 질량 분광분석의 비교
Comparison of medical history based diagnosis and urine test using ultra-performance liquid chromatographytandem mass spectrometry in drug overdose
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (19)
- Lee Je Seop, "Changes in Diagnosis of Poisoning in Patients in the Emergency Room Using Systematic Toxicological Analysis with the National Forensic Service", Journal of Korean Medical Science, 36(18), pp.1~13 (2021), 대한의학회[DOI]
- Seungho Ham, "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", Clinical and Experimental Emergency Medicine, 7(1), pp.43~51 (2020), 대한응급의학회[DOI]
- Kim K, "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, 5, pp.e008823~ (2015)
- Monte AA, "The accuracy of self-reported drug ingestion histories in emergency department patients", J Clin Pharmacol, 55, pp.33~38 (2015)
- Yagihashi G, "Diagnostic accuracy for drug detection using liquid chromatography", mass spectroscopy in overdose patients, 2020, pp.7, e487~
- 이용화, "Simultaneous Screening of 177 Drugs of Abuse in Urine Using Ultra-performance Liquid Chromatography with Tandem Mass Spectrometry in Drug-intoxicated Patients", Clinical Psychopharmacology and Neuroscience, 11(3), pp.158~164 (2013), 대한정신약물학회
- Algren DA, "Buyer Beware : Pitfalls in Toxicology Laboratory Testing", Mo Med, 112, pp.206~210 (2015)
- Tenenbein M, "Do you really need that emergency drug screen?", Clin Toxicol (Phila), 47, pp.286~291 (2009)
- 손동우, "응급실로 내원하는 급성중독환자의 원인물질 분석을 위한 중독 분석 실 이용 현황 및 이용 만족도 조사: 전국 권역 및 지역응급의료센터 설문조사", 대한임상독성학회지, 19(2), pp.110~126 (2021), 대한임상독성학회[DOI]
- Kreshak AA, "The accuracy of emergency department medication history as determined by mass spectrometry analysis of urine : a pilot study", J Emerg Med, 48, pp.382~386 (2015)
- Van Wijk XMR, "Mass spectrometry in emergency toxicology : Current state and future applications", Crit Rev Clin Lab Sci, 56, pp.225~238 (2019)
- 방해인, "Evaluation of the Triage TOX Drug Screen Assay for Detection of 11 Drugs of Abuse and Therapeutic Drugs", Annals of Laboratory Medicine, 37(6), pp.522~525 (2017), 대한진단검사의학회
- Um IK, "Availability of Toxicologic Screening Tests in the Emergency Department", J Korean Soc Clin Toxicol, 9, pp.26~29 (2011)
- Bertol E, "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, 37, pp.659~664 (2013)
- Attema-de Jonge ME, "Performance of three point-of-care urinalysis test devices for drugs of abuse and therapeutic drugs applied in the emergency department", J Emerg Med, 42, pp.682~691 (2012)
- 이세규, "응급실에서 시행한 소변 독성 검사의 유용성: 마약을 중심으로", 대한임상독성학회지, 19(1), pp.24~30 (2021), 대한임상독성학회[DOI]
- Tenore PL, "Advanced urine toxicology testing", J Addict Dis, 29, pp.436~448 (2010)
- 유재형, "급성중독 응급실 환자에서 Zolpidem 검출과 농도: 일개 중독분석실 229명 사례", 대한임상독성학회지, 17(2), pp.118~125 (2019), 대한임상독성학회[DOI]
- Caglar S, "Emergency department medication lists are not accurate", J Emerg Med, 40, pp.613~616 (2011)