Analysis Of Electronic Health Records Reveals Medication-Related Interference On Point-Of-Care Urine Drug Screening Assays

Journal of Analytical Toxicology
Nadia Ayala-LopezJacob J Hughey

Abstract

Point-of-care (POC) urine drug screening (UDS) assays provide immediate information for patient management. However, POC UDS assays can produce false positive results, which may not be recognized until confirmatory testing is completed several days later. To minimize the potential for patient harm, it is critical to identify sources of interference. Here we applied an approach based on statistical analysis of electronic health record (EHR) data to identify medications that may cause false positives on POC UDS assays. From our institution's EHR data, we extracted 120,670 POC UDS and confirmation results, covering 12 classes of target drugs, along with each individual's prior medication exposures. Our approach is based on the idea that exposure to an interfering medication will increase the odds of a false positive UDS result. For a given assay-medication pair, we quantified the association between medication exposures and UDS results as an odds ratio from logistic regression. We evaluated interference experimentally by spiking compounds into drug-free urine and testing the spiked samples on the POC device. Our dataset included 446 false positive UDS results (presumptive positive screen followed by negative confirmation). We quan...Continue Reading

References

Sep 5, 2002·Statistics in Medicine·Georg Heinze, Michael Schemper
Apr 26, 2011·Journal of the American Medical Informatics Association : JAMIA·Stuart J NelsonRobin Moore
Feb 19, 2014·Journal of Biomedical Informatics·Ioana DanciuPaul A Harris
Jul 6, 2014·Journal of Analytical Toxicology·Alec SaitmanRobert L Fitzgerald

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