Role of Urine Drug Screening in the Medical Clearance of Pediatric Psychiatric Patients: Is There One?

Objectives Our primary objective was to investigate whether urine drug screen (UDS) results affected the medical management of pediatric psychiatric patients presenting to the pediatric emergency department (ED) for psychiatric evaluation and whether it affected the final disposition of these patients. Methods This was a retrospective chart review of patients who presented to an urban pediatric ED in Newark, NJ, with psychiatric or behavior problems for medical clearance before psychiatric evaluation between June 3, 2008, and June 3, 2009. Inclusion criteria were any patient between the ages of 0 to 20 years who presented to the pediatric ED and had a UDS performed. Exclusion criteria were if the UDS was obtained for a primary medical workup such as altered mental status, known or admitted overdose, or accidental ingestions, or no psychiatric consultation was made from the ED. Abstracted descriptive data include patient’s age, sex, race, and insurance status. Visit-specific data include patient’s reason for visit, results of the UDS, psychiatric diagnosis if any, history of substance abuse if any, and management decisions other than psychiatric evaluation after medical clearance. Results A total of 875 charts were identified from laboratory records; 539 of those patients presented to the pediatric ED for psychiatric evaluation. A total of 62 patients had at least 1 substance detected on the UDS and were referred to psychiatry. All of the patients who had presented for psychiatric evaluation, including those with a positive result on the UDS, were medically cleared with no documented change in management or medical intervention in the pediatric ED. Conclusions Obtaining a UDS on patients who presented to the pediatric ED for medical clearance before psychiatric evaluation did not alter medical decision for clearance nor necessitate any change in management or interventions before psychiatric evaluation.