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A Prediction Model for Positive Infant Meconium and Urine Drug Tests
Elizabeth A Simpson1, David A Skoglund1, Sarah E Stone2
1Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Insights
This study identified four key factors predicting positive infant drug tests, simplifying screening. If a mother tests negative for drug use, infant drug testing may be unnecessary.
Area of Science:
- Neonatal Abstinence Syndrome
- Neonatal Drug Screening
- Clinical Decision Support
Background:
- Infant drug screening practices vary widely.
- Predictive factors for positive infant drug tests are not well-established.
- Current screening methods may lead to unnecessary testing.
Purpose of the Study:
- To identify factors associated with positive infant drug screens.
- To develop a shortened, predictive screening model for infants.
- To reduce unnecessary infant drug testing.
Main Methods:
- Retrospective cohort study of infants tested for drugs of abuse.
- Multivariable logistic regression to identify risk factors.
- Analysis of test characteristics for a proposed simplified screen.
Main Results:
- Four factors predicted positive infant drug tests: positive maternal urine test, substance use during pregnancy, ≤1 prenatal visit, and remote substance abuse.
- A simplified screen using these factors achieved 94% sensitivity and 69% specificity.
- Implementing this screen could reduce infant drug testing by 57%.
- No infant tested positive when the maternal drug test was negative.
Conclusions:
- A simplified screen can effectively guide clinical decisions on infant drug testing.
- Routine infant urine drug tests may be unnecessary when maternal drug test results are negative.
- This approach can optimize resource allocation and reduce healthcare costs.
Objective:
This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model.
Study Design:
This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed.
Results:
Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative.
Conclusion:
This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative.
Key Points:
· Many common drug screening criteria are not predictive.. · Four criteria predicted positive infant drug tests.. · No infant urine drug test is needed if the mother tests negative..
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