Performance of three point-of-care urinalysis test devices for drugs of abuse and therapeutic drugs applied in the emergency department.

BACKGROUND

Point-of-care tests for toxicological screening of patients for drugs of abuse and therapeutic drugs may be helpful in the emergency department (ED) to assist in a rapid diagnosis.

OBJECTIVES

In this prospective study, the performance of TesTcard9® (Varian; Middelburg, Netherlands), Syva RapidTest d.a.u. 10® (Dade Behring; Leusden, Netherlands), and Triage TOX Drug Screen® (Biosite; Bunnik, Netherlands), when applied on-site in the ED by physicians and nurses, was evaluated.

METHODS

Patients in the ED were included in the study when a physician thought the patient could benefit from a toxicological screen. Urine samples were screened utilizing the three point-of-care tests. All three tests simultaneously determined the presence of amphetamines, methamphetamine, opiates, methadone (except for TesTcard9), cocaine, cannabis, barbiturates, benzodiazepines, tricyclic antidepressants, and phencyclidine. The same urine specimen was analyzed in the pharmacy department using Syva EMIT II immunoassay and chromatographic confirmation. The results were compared for agreement.

RESULTS

During the 6-month study period, 80 urine samples were screened. In total, 62 (78%) specimens were found positive for at least one drug. Amphetamines (n = 16), cocaine (n = 27), cannabis (n = 25), benzodiazepines (n = 25), and opiates (n = 8) were the most frequently found. The sensitivity and specificity of all three devices were higher than 93% for these compounds, with the exception of the sensitivity for cannabis with the TesTcard9 (88%) and the sensitivity for benzodiazepines with the Syva RapidTest d.a.u. 10 (88%) and TesTcard9 (80%).

CONCLUSION

In the ED setting, the Triage TOX Drug Screen performed better than the other point-of-care tests, probably due to its more objective reading system and its adequate quality controls.