Utilidad de las técnicas de cribado de tóxicos en orina solicitadas desde el servicio de urgencias de un hospital pediátrico / Use of urine drug screening in the emergency department of a paediatric hospital

Objetivo: Describir las situaciones en las que se solicita cribado toxicológico en orina desde un servicio de urgencias pediátricas. Determinar si la prueba es potencialmente útil, si conlleva un cambio en el manejo del paciente y si los resultados se comprueban mediante técnicas específicas. Metodología: Estudio retrospectivo de los pacientes menores de 18 años atendidos en urgencias durante el año 2014 a los que se solicitó cribado de tóxicos en orina. Se definieron 2 grupos en función de la potencial capacidad de modificar el manejo del paciente (potencial utilidad y ausencia de utilidad). Resultados: Se recogieron 161 pacientes. En 87 casos (54,0%) el cribado de tóxicos se consideró sin potencial utilidad. En 55 pacientes (34,1%) la falta de utilidad fue debida a que la anamnesis ya explicaba la sintomatología presente, en 29 (18,0%) a que el paciente se encontraba asintomático y en 3 (1,9%) a la sospecha de intoxicación por una sustancia no detectable mediante esta técnica. El resultado ocasionó un cambio de manejo en 5 casos (3,1%). Se detectó algún tóxico en 44 pacientes (27,3%). Se solicitó confirmación con técnicas específicas en 2 (1,2%). Ambos fueron falsos positivos. Conclusiones: La mayor parte de los cribados de tóxicos solicitados no están justificados y es infrecuente que condicionen un cambio en el manejo del paciente. La confirmación mediante técnicas específicas es inusual. Su uso debe restringirse a casos concretos y, siempre que pueda tener repercusiones legales o el paciente niegue el consumo, debe seguirse de un estudio toxicológico específico que aporte un resultado concluyente (AU)

Objective: To describe the situations in which urine drug screening is used in a Paediatric Emergency Department (ED). An analysis is also made on its potential usefulness on whether it changes the patient management, and if the results are confirmed by using specific techniques. Methodology: A retrospective study was conducted on patients under the age of 18 attended in the ED during 2014 and in whom urine drug screening was requested. Depending on the potential capacity of the screening result to change patient management, two groups were defined (potentially useful and not potentially useful). Results: Urine drug screening was performed on a total of 161 patients. The screening was considered not to be potentially useful in 87 (54.0%). This was because the clinical history already explained the symptoms the patient had in 55 (34.1%) patients, in 29 (18.0%) because the patient was asymptomatic, and in 3 (1.9%) because the suspected drug was not detectable in the screening. The drug screening results changed the patient management in 5 (3.1%) cases. A toxic substance was detected in 44 (27.3%). Two out of the 44 that were positive (2.1%) were re-tested by specific techniques, and presence of the toxic substance was ruled out in both of them (false positives). Conclusions: Most of the drug screening tests are not justified, and it is very infrequent that they change patient management. It is very rare that the results are confirmed using more specific methods. Urine drug screening tests should be restricted to particular cases and if the result has legal implications, or if the patient denies using the drug, it should be followed by a specific toxicological study to provide a conclusive result (AU)

[Use of urine drug screening in the emergency department of a paediatric hospital]. / Utilidad de las técnicas de cribado de tóxicos en orina solicitadas desde el servicio de urgencias de un hospital pediátrico.

OBJECTIVE: To describe the situations in which urine drug screening is used in a Paediatric Emergency Department (ED). An analysis is also made on its potential usefulness on whether it changes the patient management, and if the results are confirmed by using specific techniques. METHODOLOGY: A retrospective study was conducted on patients under the age of 18 attended in the ED during 2014 and in whom urine drug screening was requested. Depending on the potential capacity of the screening result to change patient management, two groups were defined (potentially useful and not potentially useful). RESULTS: Urine drug screening was performed on a total of 161 patients. The screening was considered not to be potentially useful in 87 (54.0%). This was because the clinical history already explained the symptoms the patient had in 55 (34.1%) patients, in 29 (18.0%) because the patient was asymptomatic, and in 3 (1.9%) because the suspected drug was not detectable in the screening. The drug screening results changed the patient management in 5 (3.1%) cases. A toxic substance was detected in 44 (27.3%). Two out of the 44 that were positive (2.1%) were re-tested by specific techniques, and presence of the toxic substance was ruled out in both of them (false positives). CONCLUSIONS: Most of the drug screening tests are not justified, and it is very infrequent that they change patient management. It is very rare that the results are confirmed using more specific methods. Urine drug screening tests should be restricted to particular cases and if the result has legal implications, or if the patient denies using the drug, it should be followed by a specific toxicological study to provide a conclusive result.

Procalcitonin to detect invasive bacterial infection in non-toxic-appearing infants with fever without apparent source in the emergency department.

The reliability of procalcitonin as a predictor of invasive infection in infants <36 months of age with fever and nontoxic appearance was assessed in 868 patients, 15 (1.7%) of whom had invasive infection. The area under the receiver operating characteristic curve for procalcitonin was 0.87 (optimum cutoff 0.9 ng/mL, sensitivity 86.7%, specificity 90.5%), whereas for C-reactive protein it was 0.79 (optimum cutoff 91 mg/L, sensitivity 33.3%, specificity 95.9%). In infants with fever of <8 hours duration, the area under the receiver operating characteristic curve was 0.97 for procalcitonin and 0.76 for C-reactive protein. Procalcitonin was a useful biomarker to predict invasive infection in non-toxic-appearing infants with fever without apparent focus, particularly in febrile episodes of <8 hours duration.

Consultsa urgentes de adolescentes por consumo de alcohol y otras sustancias psicoactivas / Consultations about drugs and alcohol abuse among adolescents in an emergency department

Fundamento. En los últimos años, la edad media de inicio del consumo de alcohol y otras drogas ha disminuido, y las consultas derivadas de su consumo son cada vez más frecuentes en los servicios de urgencias. Objetivo. Documentar el papel del Alcohol y otras Sustancias Psicoactivas (ASP) en las consultas de los adolescentes. Método. Estudio descriptivo observacional de los adolescentes que consultaron en Urgencias durante los años 2007 y 2008 con clínica secundaria al consumo de ASP. Resultados. Se realizaron 263 (1%) consultas con clínica relacionada con ASP (principalmente alteración de la conciencia; 200, 76%). Correspondían a 258 pacientes; cinco (1,9%) consultaron dos veces. La edad media fue de 16,1 (DE 1,1) años; el 50,4% eran chicos. El 76,4% fueron trasladados en ambulancia, con predominio de consultas de viernes a domingo (63,8%) y de 19:00 a 07:00 h (79,1%). En 198 (75,3%) consultas los pacientes presentaban intoxicación etílica, en 149 (75,3%) se determinaron niveles de alcohol en sangre, siendo la concentración media de 191 (DE 53) mg/dl. De las otras drogas, se detectó cannabis en 70 (26,65) consultas, cocaína en 11 (4,2%), anfetaminas en 5 (1,9%), opiáceos en 4 (1,5%) y benzodiacepinas en 3 (1,1%). También hubo dos casos (0,8%) de inhalación de disolventes. Veintiocho (10,6%) casos dieron positivo para dos tóxicos, las combinaciones más frecuentes fueron alcohol-cannabis (14; 50%) y cannabiscocaína (5; 17,8%), y uno (0,4%), por tres (alcohol-cannabis-cocaína). Conclusiones. El consumo abusivo de alcohol es la causa más frecuente de intoxicación en adolescentes. Existe un porcentaje considerable de poli-intoxicaciones. Los fines de semana y las noches son los momentos de más consultas, probablemente por el consumo ligado al tiempo de ocio(AU)

Background. Substance abuse is a public health concern. Lately, the mean age of drug and alcohol consumption initiation has decreased and the number of emergency consultations about their abuse has increased. Objective. To describe the characteristics of adolescents presenting to the emergency department due to drug and alcohol abuse. Method. We conducted an observational and descriptive study of all patients aged 12-18 years presenting to a pediatric emergency department between 1 January 2007 and 31 December 2008 with drugs and/or alcohol abuse symptoms. Results. 263 emergency consultations corresponding to 258 patients were included (there were 5 (1.9%) patients with 2 consultations). Their mean age was 16.1(SD 1.1) years; 50.4% were males. 76.4% of them arrived by ambulance. Patients with substance abuse were overrepresented during the weekend (63.8%) and during the night (79.1%). The decreased level of consciousness was the main symptom in 200 (76%). There were 198 (75.3%) patients with alcohol intoxication, in 149 (75.3%) of them blood ethanol level was determined (mean 191mg/dl; SD 53mg/dl). The other reported drugs were cannabis (70; 26.7%), cocaine (11; 4.2%), amphetamines (5; 1.9%), opiates (4; 1.5%), benzodiazepine (3; 1.1%) and volatile substances (2; 0.8%). In 28 cases (10.6%) two drugs were combined (most frequent combinations: alcohol-cannabis (14; 50%) and cannabis-cocaine (5; 17.8%); and in one (0.4%) three (alcohol-cannabis-cocaine). Conclusions. Abuse of alcohol is the most frequent cause of adolescent intoxication. There is an important proportion of poly-drug abuses. A high number of patients with drug abuse arrive to Emergency Department during weekends and nights, probably in connection with their use of the free time(AU)