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Utility of comprehensive toxicologic screens in children

M G Belson1, H K Simon

  • 1Department of Pediatrics, Georgia Poison Center, Emory University School of Medicine, Atlanta, USA.

The American Journal of Emergency Medicine
|May 25, 1999
PubMed

Insights

The high-performance liquid chromatography (HPLC) component of comprehensive toxicology screens in children offers no additional clinical benefit over a limited screen. This expensive HPLC addition did not alter patient management in any cases, making it clinically insignificant.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Toxicology

Background:

  • Comprehensive toxicologic screens are utilized in pediatric emergency departments.
  • Evaluating the clinical utility and cost-effectiveness of different components of these screens is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

  • To compare the clinical utility and cost-effectiveness of the limited component versus the high-performance liquid chromatography (HPLC) component of comprehensive toxicologic screens in children.
  • To determine if the broad-spectrum HPLC component provides additional clinical benefit beyond the limited screen in pediatric toxicology cases.

Main Methods:

  • Retrospective review of pediatric patients (<19 years) undergoing comprehensive toxicologic screens between January 1994 and July 1995.
  • Analysis of screen results, categorizing toxins by origin, clinical suspicion, and significance.
  • Comparison of findings between the limited and HPLC components of the screens, with chart review for clinical impact.

Main Results:

  • Out of 463 comprehensive screens, 234 (51%) were positive for exogenous toxins.
  • In 97% of positive screens, toxins were suspected, detected by the limited screen, or clinically insignificant.
  • Only 3% of positive screens (7 cases) detected clinically significant toxins solely by HPLC, with no change in patient management.

Conclusions:

  • The broad-spectrum HPLC component of comprehensive toxicology screens in children provides no additional clinical benefit compared to the limited component alone.
  • The HPLC component significantly increases costs without altering patient management, suggesting it is not clinically useful in this setting.

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