RT Journal Article
SR Electronic
T1 Urine toxicology screening in an urban stroke and TIA population
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1702
OP 1709
DO 10.1212/WNL.0b013e318293e2fe
VO 80
IS 18
A1 Brian Silver
A1 Daniel Miller
A1 Michelle Jankowski
A1 Nawaf Murshed
A1 Patricia Garcia
A1 Patricia Penstone
A1 Melissa Straub
A1 Sean P. Logan
A1 Anita Sinha
A1 Daniel C. Morris
A1 Angelos Katramados
A1 Andrew N. Russman
A1 Panayiotis D. Mitsias
A1 Lonni R. Schultz
YR 2013
UL http://n.neurology.org/content/80/18/1702.abstract
AB Objective: We sought to determine the rate of urine toxicology screening, differences in testing, and outcomes among patients with stroke and TIA presenting to a tertiary care emergency department.Methods: In this retrospective cohort study, patients admitted with stroke or TIA to a single tertiary care stroke center between June 2005 and January 2007 were identified through a stroke database. Factors that predicted urine toxicology screening of patients and a positive test, and discharge outcomes of patients based on toxicology result were analyzed. Stroke severity, treatment with tissue plasminogen activator, discharge status, and stroke etiology were compared between toxicology positive and negative patients.Results: A total of 1,024 patients were identified: 704 with ischemic stroke, 133 with intracerebral hemorrhage, and 205 with TIA. Urine toxicology screening was performed in 420 patients (40%); 11% of these studies were positive for cocaine (19% younger than 50 years and 9% 50 years or older). Factors that significantly predicted the performance of a urine toxicology screen were younger age (<50 years) and black race (<0.001). Positive toxicology screens occurred in a broad range of patients. There were no significant differences in admission NIH Stroke Scale score, stroke etiology, and discharge status between toxicology-positive and -negative patients.Conclusions: In this study, patients with stroke and TIA who were young and black were more likely to have urine toxicology screening. Eleven percent of all tested patients (and 9% of patients 50 years or older) were positive for cocaine. To avoid disparities, we suggest that all stroke and TIA patients be tested.MDMA=3,4-methylenedioxy-N-methylamphetamin; NIHSS=NIH Stroke Scale; TOAST=Trial of Org 10172 in Acute Stroke Treatment; tPA=tissue plasminogen activator