Validation of a Rapid Urine Screening Assay for Cocaine Use among Pregnant Emergency Patients

Abstract

Objectives:To determine the accuracy of the OnTrak rapid urine latex agglutination immunoassay (AIA) for testing pregnant ED patients for the cocaine metabolite benzoylecgonine (BE), and to determine the frequency of urine BE in pregnant E D patients and the association of test results with patient demographics.Methods: A test performance evaluation was conducted using an inception cohort of pregnant patients at an urban teaching hospital ED. Patients with positive urine chorionic gonadotropin tests who had adequate remaining urine samples were studied. Patient demographics, E D diagnoses, and assay results were recorded without patient identifiers. Urine was tested using the rapid AIA. The first 150 samples were confirmed using a second immunoassay and gas chromatography with a nitrogen phosphorus detector. All positive samples also were confirmed with thin-layer chromatography, and quantification by gas chromatography-mass spectrometry.Results: Twenty of 342 (5.9%, 95% CI 3.4-8.4%) pregnant patients had urine samples positive by AIA testing for BE. Confirmation testing demonstrated no false-positive or -negative AIA result. Positive test results were not associated with specific patient diagnoses or demographics.Conclusions: E D screening for cocaine use among pregnant patients can be accurately performed using the OnTrak AIA for BE. In the E D population screened, 5.9% of the pregnant women had urine samples positive for BE.Acad. Emerg. Med. 1995; 2:795-798.

Identification of polysubstance abuse in the parturient

“…We evaluated a rapid and inexpensive screening test that was found to identify illicit substances that had been ingested within the previous 72 h. The TesTcupÔ has been shown to be an accurate assay 9 and has been utilized by many specialties and in emergency situations. 10 In this study, an anaesthetist without special training in toxicology testing was able to complete the tests in less than 5 min with results identical to those reported by the hospital laboratory. It should be noted, however, that latex agglutination tests do not provide a quantitative analysis.…”