A case series evaluation of comprehensive drug testing in the pediatric acute care setting

• Published in: Journal of mass spectrometry and advances in the clinical lab 2023-04, Vol.28, p.75-79
• Main Author: Lynch, Kara L.
• Format: Article
• Language: English
• Subjects: Analytical toxicology; Clinical toxicology; Comprehensive drug testing; Drug exposure; Drug testing; High resolution mass spectrometry; Laboratory developed test; Pediatric toxicology
• ISSN: 2667-145X; 2667-1468; 2667-145X
• DOI: 10.1016/j.jmsacl.2023.02.011

•Demonstration of the utility of real-time comprehensive drug testing for acute care pediatric cases.•Results, when negative, rule-out toxic exposure, allowing for investigation into alternative causes of symptoms.•Results, when positive, lead to appropriate medical and social interventions.•Results inconsistent with medical history were determined to be due to accidental ingestion of prescribed medication or an illicit substance. Drug testing typically follows a one-size-fits-all approach that is inadequate in some clinical scenarios, such as child maltreatment, neglect, and unintentional drug exposure. Results from immunoassay-based testing, which are non-specific, insensitive, and far from comprehensive, can lead to unintended consequences for children and their families. The objective of this retrospective case series study is to evaluate the utility of real-time (0–1 day) comprehensive drug testing as an alternative to immunoassay-based testing in the pediatric acute care setting. Comprehensive drug testing results obtained by mass spectrometry testing and associated medical data for all pediatric cases (0–12 years) at one institution from 2019 to 2022 were included in the analysis. The final case series (n = 7) included all cases from patients