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Role of laboratory tests in managing acute poisonings: a survey of emergency physicians

Castanyer Puig B, Puiguriguer Ferrado J, Barceló Martín B, Nogué Xarau S

Servicio de An√°lisis Cl√≠nicos y Unidad de Toxicolog√≠a, Servicio de Urgencias y Unidad de Toxicolog√≠a, Hospital Universitari Son Espases, Palma de Mallorca, Spain. Secci√≥n de Toxicolog√≠a, √Ārea de Urgencias, Hospital Cl√≠nic, Barcelona, Spain. Grupo de Investigaci√≥n ¬ďUrgencias: procesos y patolog√≠as¬Ē, IDIBAPS, Barcelona, Spain.

Objective: To survey physicians who treat acute poisoning cases to determine their
attitudes toward laboratory testing in these cases and also toward certain tests for the
management of common poisonings.
Methods: A questionnaire was sent to physicians working in the emergency
departments of 2 hospitals with toxicology units and to physicians attending toxicology
training courses. Survey items asked about professional data; the degree of importance
the physicians attached to laboratory testing at different stages in the care process;
which 3 tests the respondents considered important in 17 different acute poisoning
scenarios; and which laboratory test they considered highly important was unavailable at
the hospitals where the physicians worked.
Results: Eighty-eight valid questionnaires were returned; 69 of them (78%) were from
physicians attending toxicology courses and 19 (22%) were from emergency room
physicians. The respondents in both groups believed that laboratory tests were most
important when cases of acute poisoning were being diagnosed; 62% of the emergency
department physicians and 58% of the trainee physicians expressed that opinion. More
emergency department physicians at hospitals with toxicology units considered
laboratory testing to be of great importance (52% of such physicians vs 26% of the
trainees, P<.05). In the 17 poisoning scenarios considered, the respondents named as
their first choice a urine test to screen for drug abuse (benzodiazepines, antidepressants
[tricyclics and selective serotonin uptake inhibitors]; heroine; GHB [gammahydroxybutyrate];
and ecstasy). A specific quantitative test that could detect the cause of
poisoning was named as first choice only for smoke inhalation, in which case the
respondents would measure carboxyhemoglobin concentration. Tests named for other
poisonings were nonspecific.
Conclusions: The surveyed physicians confirmed that the purpose of laboratory testing
in toxicology is to confirm the diagnosis suggested by the patient’s symptoms.

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