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Hospital-based toxicology: patterns of use and abuse
J G Schwartz1, J H Stuckey, T J Prihoda
1Department of Pathology, University of Texas Health Science Center, San Antonio 78284-7750.
Texas Medicine
|June 1, 1990
Summary
Toxicology lab results frequently disagreed with clinical impressions, with only 17.4% concordance. Age and sex influenced drug detection, but temporal patterns were inconsistent, except for benzodiazepines.
Area of Science:
- Clinical Toxicology
- Forensic Chemistry
- Hospital Laboratory Medicine
Background:
- Toxicology testing is crucial for patient care and diagnosis.
- Understanding patterns in toxicology requests aids resource allocation and clinical practice.
Purpose of the Study:
- To analyze the patterns and characteristics of toxicology requests in a hospital setting.
- To assess the concordance between clinical suspicion and laboratory findings.
- To identify factors influencing toxicology testing outcomes.
Main Methods:
- Retrospective analysis of 949 consecutive toxicology requests.
- Evaluation of drug detection frequencies, concordance rates, and demographic influences.
- Assessment of temporal trends and inappropriate request rates.
Main Results:
- Laboratory analysis confirmed clinical impression in only 17.4% of cases.
- Age and sex showed correlation with specific drug detections.
- No consistent temporal patterns were observed for most drugs, except benzodiazepines.
- Certain weekdays significantly impacted request volume; seasons, holidays, and lunar phases did not.
- Inappropriate toxicology requests accounted for 9% of the caseload.
Conclusions:
- Significant discordance exists between clinical impressions and toxicology laboratory results.
- Demographic factors influence drug detection, necessitating tailored testing strategies.
- Hospital toxicology services face challenges with inappropriate requests and require optimization.