Chief complaint, drug testing, and neuroimaging for cannabis poisoning in the emergency department

Cannabis ingestions in young children frequently lead to emergency department (ED) visits requiring substantial diagnostic evaluation, including advanced neuroimaging. We assessed the relationship between presenting chief complaint, timing of cannabis test results, and the use of advanced neuroimaging in these visits.

In this retrospective study using Epic's Cosmos database (January 2016 - June 2024), we included ED visits for children <6 years with a cannabis poisoning diagnosis and cannabis laboratory test. We described clinical characteristics and illustrated timing of drug testing results during these ED visits. We compared use of neuroimaging by chief complaint, using chi-squared tests and logistic regression.

There were 3653 encounters included. Median age was 29 (IQR 16-45) months and the cohort was 51 % female, 41 % White, 35 % Black, and 15 % Hispanic. The most common category of chief complaint was altered mental status (39 %), followed by ingestion/exposure (35 %), with seizures/abnormal movements present in 5 %. The median times from ED arrival to cannabis test collection and result were 93 (IQR 40-208) and 152 (IQR 90-277) minutes respectively. Neuroimaging was performed in 35 % of encounters, with significantly lower use in those with ingestion vs. neurologic chief complaints (8.8 % vs. 56 %; OR 0.08, 95 % CI: 0.06-0.10).

For children with cannabis poisoning, drug screen results were frequently unavailable until late in ED visits, and presenting chief complaint strongly influenced the use of neuroimaging. These findings underscore the need for strategies to facilitate early caregiver disclosure of ingestion and expedite drug screening to optimize care.