Screening for stimulant use in adult emergency department seizure patients.

OBJECTIVE: The objective of this study was to determine the prevalence of positive plasma drug screening for cocaine or amphetamine in adult emergency department seizure patients. METHODS: This prospective study evaluated consecutive eligible seizure patients who had a plasma sample collected as part of their clinical evaluation. Plasma was tested for amphetamine and the cocaine metabolite benzoylecgonine using enzyme-mediated immunoassay methodology. Plasma samples with benzoylecgonine greater than 150 ng/mL or an amphetamine greater than 500 ng/mL were defined as positive. Patient demographics, history of underlying drug or alcohol-related seizure disorder, estimated time from seizure to sample collection, history or suspicion of cocaine or amphetamine abuse, results of clinical urine testing for drugs of abuse, and assay results were recorded without patient identifiers. RESULTS: Fourteen of 248 (5.6%, 95% CI 2.7%-8.5%) plasma samples were positive by immunoassay testing for benzoylecgonine and no samples (0%, 95% CI 0-1.2%) were positive for amphetamine. Positive test results were more common in patient visits where there was a history or suspicion of cocaine or amphetamine abuse (p < 0.0005). CONCLUSIONS: During this study period, routine plasma screening for cocaine and amphetamines in adult seizure patients had a low yield. As a result, routine plasma screening would yield few cases of stimulant drug in which there was neither a history nor suspicion of drug abuse in this population.

Oleoresin capsicum (Cap-Stun) toxicity from aerosol exposure.

OBJECTIVE: To describe the clinical toxicity caused by oleoresin capsicum (OC) spray during law-enforcement action. DESIGN: A medical record review. SETTING: Emergency department (ED), Truman Medical Center, Kansas City, MO. PATIENTS: Consecutive patients who presented to the ED after OC-spray exposure from law-enforcement action between June 1991 and June 1994. MAIN OUTCOME MEASURES: Patient presentation and symptoms at presentation, evaluation, and treatment during ED stay. RESULTS: Eighty-one ED patients, approximately 10% of all individuals sprayed by police officers, presented after exposure to OC. Ocular burning and redness were the most common presenting symptoms. None of the patients required hospitalization due to OC toxicity. Corneal abrasions and respiratory symptoms occurred in 7 and 6 patients, respectively. CONCLUSIONS: The need for ED evaluation and treatment was infrequent after exposure to OC. A transient burning sensation, erythema, and localized irritation were the most common findings. While no patients had adverse outcomes attributed to OC exposure, practitioners assessing exposure should consider the potential for pulmonary and ocular toxicity.

Validation of a rapid urine screening assay for cocaine use among pregnant emergency patients.

OBJECTIVES: To determine the accuracy of the OnTrak rapid urine latex agglutination immunoassay (AIA) for testing pregnant ED patients for the cocaine metabolite benzoylecgonine (BE), and to determine the frequency of urine BE in pregnant ED patients and the association of test results with patient demographics. METHODS: A test performance evaluation was conducted using an inception cohort of pregnant patients at an urban teaching hospital ED. Patients with positive urine chorionic gonadotropin tests who had adequate remaining urine samples were studied. Patient demographics, ED diagnoses, and assay results were recorded without patient identifiers. Urine was tested using the rapid AIA. The first 150 samples were confirmed using a second immunoassay and gas chromatography with a nitrogen phosphorus detector. All positive samples also were confirmed with thin-layer chromatography, and quantification by gas chromatography-mass spectrometry. RESULTS: Twenty of 342 (5.9%, 95% CI 3.4-8.4%) pregnant patients had urine samples positive by AIA testing for BE. Confirmation testing demonstrated no false-positive or -negative AIA result. Positive test results were not associated with specific patient diagnoses or demographics. CONCLUSIONS: ED screening for cocaine use among pregnant patients can be accurately performed using the OnTrak AIA for BE. In the ED population screened, 5.9% of the pregnant women had urine samples positive for BE.