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HOME > J Korean Soc Clin Toxicol > Volume 20(1); 2022 > Article
Comparison of medical history based diagnosis and urine test using ultra-performance liquid chromatography-tandem mass spectrometry in drug overdose
Ja-Young Lee, Kyungman Cha, Won Jung Jeong, Hyung Min Kim, Byung Hak So
Journal of The Korean Society of Clinical Toxicology 2022;20(1):1-7
DOI: https://doi.org/10.22537/jksct.2022.20.1.1
Published online: June 30, 2022
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1Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
2Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
3Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
4Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
5Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea

Purpose: In patients with acute drug overdose, identification of drugs ingested is crucial to make a precise diagnosis. In most cases, the diagnoses are made on the medical history and physical examination findings. This study was undertaken to determine the concordance of diagnosis made on the basis of patient history by comparing it with urine toxicology analysis. Methods: This was a retrospective study of drug intoxicated patients over 18 years old who presented to the emergency center from 2017 to 2019. Specimens from urine were tested using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-TMS). The test results were compared with information obtained from patients. Diagnostic concordances for drug detection in intoxicated patients were calculated. Logistic regression analysis was used to examine the association between clinical characteristics and diagnostic discrepancy. Results: Totally, 370 patients were included in the analysis. Overall, 66 types of drugs were detected by UPLC-TMS. The drugs detected most frequently were zolpidem (104, 27.8%), citalopram (70, 18.7%), and paracetamol (66, 17.6%). The mean diagnostic concordance of patients was 52.7%. There were statistically significant diagnostic discrepancies in patients with underlying depression and patients intoxicated with multiple types of drugs. Conclusion: In ED patients with acute drug overdose, the diagnoses made on history alone were often inaccurate. It is essential to perform urine toxicology tests such as UPLC-TMS as a confirmatory instrument to improve accuracy in evaluating patients with drug intoxication.

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JKSCT : Journal of The Korean Society of Clinical Toxicology