急性薬物中毒におけるTriage DOA ® の臨床的有用性

Abstract

Clinical utility of the Triage DOA in patients with acute drug intoxication Rie Yamamoto , Takeshi Saito , Hiromichi Aoki , Shinichi Iizuka 2 Kazuki Akieda , Sadaki Inokuchi 1 1 Department of Emergency and Critical Care Medicine, Tokai University School of Medicine 2 Fuji Heavy Industries Health Insurance Society, Ota Memorial Hospital Emergency and Critical Care Medicine Acute drug intoxication is one of the most important fields in emergency medicine, and the specific characteristics of the drug that caused intoxication are critical for determining the most appropriate treatment. Because it is not possible to conduct the quantitative analysis using specialized instrumentation at all medical facilities, handy screening kits that allow for the prompt determination of drug characteristics are now available in many medical facilities. However, screening kits often have limited analytical capacity, and there are false-positive and false-negative in the kits. In the present study, we examined the clinical utility of the Triage DOA kit, as the gold standard for performing quantitative analyses. Patients participating in the study were hospitalized at the Emergency Medical Center of our institution between April 2009 and March 2013. A total of 822 cases of acute drug intoxication were analyzed using quantitative analyses and the Triage DOA. The sensitivity, specificity, false-negative rate, false-positive rate, negative predictive value and positive predictive value of the Triage DOA for detecting and measuring the characteristics of benzodiazepine (BZO), barbituric acid (BAR), tricyclic antidepressant (TCA) and amphetamine (AMP) were examined. The results demonstrated that, although there are some problems the Triage DOA, it was nevertheless effective for the initial screening and treatment selection in our emergency department. However, because the positive predictive value for TCA and AMP was low and the negative predictive value for BZO was low, the results of the Triage DOA tests should therefore be interpreted with great caution in the emergency setting. Moreover, several cases of acute drug intoxication with antipsychotics, selective serotonin reuptake inhibitor and serotonin and norepinephrine reuptake inhibitor have been reported. These drugs cannot be detected with the Triage DOA. Therefore, it is possible that the individual being tested has used these drugs, even if the screening kit yields negative results. Physicians should therefore carefully consider this possibility when determining the initial treatment option. (JJAAM. 2014; 25: 865-73)