Utility of toxicology screening in a pediatric emergency department

Objective: To determine the types of patients who undergo toxicology screen testing (TS) and the clinical utility of the test in a pediatric emergency department. Design: Retrospective chart review. Setting: Urban pediatric emergency department. Patients or participants: All patients, n = 338, less than 18 years of age who had a TS sent from the Kosair Children's Hospital Emergency Department between 1/1/91 and 12/31/91. Results: Three hundred and thirty-eight charts were available for review from 344 patients who had TS testing. Seventy-eight patients (23%) were less than 12 years old; 164 patients (49 %) were female. Forty-four patients were tested by serum TS only; 195 patients by serum plus urine TS; 94 patients by urine TS; four patients by serum, urine, and gastric aspirate TS, and one patient by urine and gastric aspirate TS. Chief complaints of patients who had TS sent were as follows: ingestion (211), abnormal behavior (56), seizures (30), trauma (18), syncope/tingling (7), depression/suicide (6), chest pain/palpitations (3), headaches (3), and other (4). While 195 patients (57%) had positive TS for at least one item, only 22 patients (7%) had a positive TS for an unexpected item, including seven patients with ingestions, eight with abnormal behavior, four with seizures, two with syncope, and one with trauma. Only three patients with unexpected positive TS had a change in medical management as a result of the TS findings. All three of these patients had abnormal physical examinations. Conclusion: A minority of patients have unexpected TS results. TS results rarely necessitate a change in medical management. Emergency physicians should reevaluate indications for TS testing in pediatric patients.