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Utility of pediatric urinalysis to screen for paracetamol intake: a preliminary study

Martínez Sánchez L, Quintillá Martínez JM, Molina Hermoso E, Castanyer I Puig T, Barceló Martín B, Valls Lafon A, Luaces Cubells C

Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Spain, Unidad de Toxicología, Hospital Universitari Son Espases, Palma de Mallorca, Spain.

Objective: To explore whether urinalysis to screen for paracetamol intake, following the
same procedure as is used for blood analysis, would be useful.
Methods: Retrospective cross-sectional, descriptive-analytical study of a random sample
of patients for whom urine tests were ordered in an emergency department. The data
were classified into 2 groups, according to whether the patients had or had not taken a
therapeutic dose of paracetamol during the previous 24 hours. Paracetamol
concentration in urine was measured for all patients. We compared the percentages of
patients with positive findings between groups and calculated the sensitivity, specificity,
and positive and negative predictive values of urinalysis for paracetamol.
Results: A total of 161 children between the ages of 17 days and 17 years were included;
83 had taken paracetamol and 78 had not. Urine tests were positive for all patients in the
first group and for 7.7% in the second group. The sensitivity of the test was 100% (95%
confidence interval [CI], 95.6%-100%) and the specificity was 92.31% (95% CI, 84.22%-
96.43%). No patient who had taken paracetamol had a negative urine test (negative
predictive value, 100%; 95% CI, 94.93%-100%).
Conclusions: Urinalysis to screen for paracetamol intake in the previous 24 hours is
useful. A negative result would make blood testing unnecessary. This approach to
screening would clearly benefit young children who may have taken the medication
accidentally or adolescents who may have used it to attempt suicide.

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