Broad-Spectrum Drug Screening Positivity Rates in Pediatrics and Adults: The Reference Laboratory Perspective

Broad-spectrum drug testing is useful in various practical settings, especially when patients present with unknown exposures. Although national poison control data inform trends in toxicity and poison control calls, a need exists for clinical drug detection data across different patient populations.

To address this need, this retrospective study analyzed drug positivity rates from plasma and urine samples tested on a 127-analyte broad-spectrum drug panel. Samples were stratified by sex and age groups (pediatric <18 years, adult ≥18 years). Positivity rates for drug classes and copositivity patterns were compared using χ 2 testing with Bonferroni correction.

In total, 7750 samples (3140 plasma and 4610 urine) were analyzed. Positivity for at least one of the tested analytes was high (86% in plasma and 82% in urine). In urine, significant differences in positivity rates between male and female patients were observed for anticonvulsants, antidepressants, antihistamines, benzodiazepines, muscle relaxants, and nicotine. All substances were more prevalent in female patients, except nicotine. Copositivity was more common in female patients, who were more likely than male patients to test positive for 2 or more drug classes. Pediatrics were more likely than adults to test positive for sedatives but less likely for most other drug classes. Overall, patterns of drug class detection differed significantly by age and sex.

This retrospective study reports real-world positivity patterns in a broad-spectrum drug panel, including significant sex- and age-based differences. The higher rates of copositivity in female patients and the higher prevalence of sedatives in pediatric patients are clinically relevant for interpreting drug screen results and managing acute toxidromes. These findings may be useful to both acute care decision making and public health policy interventions, particularly in the pediatric setting.