Emily Neal

Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Robertson, Sara

Committee Member

Hall, Lynne


Background: The drug epidemic is plaguing the United States and more Americans than ever have been identified to use illicit substances regularly, including while caring for children. The practice of obtaining a standard urine or serum drug screen is outdated and ineffective in determining if children have been exposed to illicit substances. Often these immunoassay drug screens are negative despite pediatric patients having symptomatic responses to illicit drug exposures. Immunoassay drug screens are not designed for testing in children who are often passively and directly exposed as bystanders to adult drug use in their environment. This means that a “negative” result can only be interpreted in this context as “inconclusive” rather than “not exposed.

Purpose: The purpose of this paper was to evaluate the positivity rate for targeted serum and urine toxicology results in children less than 5 years of age where illicit drug exposure is highly suspected.

Design: Retrospective chart review of data collected on targeted serum and/or urine results from 2016-2020 from a child abuse program.

Setting: A Child Abuse Program that evaluates nearly 1,200 patients yearly who are suspected of abuse or neglect in a large metropolitan area, after the implementation of new toxicology testing practices.

Procedure: Secondary analysis of existing data was conducted to determine the positivity rate for certain serum and urine toxicology results.

Results: 174 charts met inclusion criteria for the retrospective review. Of the 174, 141 charts had a standard immunoassay drug screen obtained, 96 of these were negative for any substances.

When targeted testing was utilized, of the 96 charts with negative results, 69 charts later had identifiable substances.

Conclusions: This retrospective chart review supports a change in the management of acute ingestions in children, specifically the use of targeted testing for specific suspected substances. This method is more sensitive and specific (lower thresholds). The data supports the need for further studies.

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Nursing Commons