Role of laboratory tests in managing acute poisonings: a survey of emergency physicians

Objective: To survey physicians who treat acute poisoning cases to determine their attitudes toward laboratory testing in these cases and also toward certain tests for the management of common poisonings. Methods: A questionnaire was sent to physicians working in the emergency departments of 2 hospitals with toxicology units and to physicians attending toxicology training courses. Survey items asked about professional data; the degree of importance the physicians attached to laboratory testing at different stages in the care process; which 3 tests the respondents considered important in 17 different acute poisoning scenarios; and which laboratory test they considered highly important was unavailable at the hospitals where the physicians worked. Results: Eighty-eight valid questionnaires were returned; 69 of them (78%) were from physicians attending toxicology courses and 19 (22%) were from emergency room physicians. The respondents in both groups believed that laboratory tests were most important when cases of acute poisoning were being diagnosed; 62% of the emergency department physicians and 58% of the trainee physicians expressed that opinion. More emergency department physicians at hospitals with toxicology units considered laboratory testing to be of great importance (52% of such physicians vs 26% of the trainees, P<.05). In the 17 poisoning scenarios considered, the respondents named as their first choice a urine test to screen for drug abuse (benzodiazepines, antidepressants [tricyclics and selective serotonin uptake inhibitors]; heroine; GHB [gamma-hydroxybutyrate]; and ecstasy). A specific quantitative test that could detect the cause of poisoning was named as first choice only for smoke inhalation, in which case the respondents would measure carboxyhemoglobin concentration. Tests named for other poisonings were nonspecific. Conclusions: The surveyed physicians confirmed that the purpose of laboratory testing in toxicology is to confirm the diagnosis suggested by the patient's symptoms. [Emergencias 2012;24:447-453]