PMID- 33216907
OWN - NLM
STAT- MEDLINE
DCOM- 20220215
LR  - 20220531
IS  - 1945-2403 (Electronic)
IS  - 0146-4760 (Print)
IS  - 0146-4760 (Linking)
VI  - 46
IP  - 1
DP  - 2022 Feb 14
TI  - Analysis of Electronic Health Records Reveals Medication-Related Interference on 
      Point-of-Care Urine Drug Screening Assays.
PG  - 99-102
LID - 10.1093/jat/bkaa179 [doi]
AB  - 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 
      quantified the odds ratio of false positives for 528 assay-medication pairs. Of 
      the six assay-medication pairs we evaluated experimentally, two showed 
      interference capable of producing a presumptive positive: labetalol on the 
      3,4-methylenedioxymethamphetamine (MDMA) assay (at 200 mug/mL) and ranitidine on 
      the methamphetamine assay (at 50 mug/mL). Ranitidine also produced a presumptive 
      positive for opiates at 1,600 mug/mL and for propoxyphene at 800 mug/mL. These 
      findings highlight the generalizability and the limits of our approach to use EHR 
      data to identify medications that interfere with clinical immunoassays.
CI  - (c) The Author(s) 2020. Published by Oxford University Press. All rights reserved. 
      For permissions, please e-mail: journals.permissions@oup.com.
FAU - Ayala-Lopez, Nadia
AU  - Ayala-Lopez N
AD  - Department of Pathology, Microbiology, and Immunology, Vanderbilt University 
      Medical Center, 1161 21st Ave South, Nashville, TN, 37232 USA.
FAU - Colby, Jennifer M
AU  - Colby JM
AD  - Department of Pathology, Microbiology, and Immunology, Vanderbilt University 
      Medical Center, 1161 21st Ave South, Nashville, TN, 37232 USA.
FAU - Hughey, Jacob J
AU  - Hughey JJ
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 
      West End Ave, Nashville, TN, 37203 USA.
LA  - eng
GR  - UL1 TR002243/TR/NCATS NIH HHS/United States
GR  - UL1TR002243/TR/NCATS NIH HHS/United States
PT  - Journal Article
PL  - England
TA  - J Anal Toxicol
JT  - Journal of analytical toxicology
JID - 7705085
SB  - IM
MH  - *Electronic Health Records
MH  - False Positive Reactions
MH  - Humans
MH  - *Point-of-Care Systems
MH  - *Substance Abuse Detection
MH  - *Urinalysis
PMC - PMC8841984
EDAT- 2020/11/21 06:00
MHDA- 2022/02/16 06:00
PMCR- 2021/11/20
CRDT- 2020/11/20 17:15
PHST- 2020/08/24 00:00 [received]
PHST- 2020/11/10 00:00 [revised]
PHST- 2020/11/19 00:00 [accepted]
PHST- 2020/11/21 06:00 [pubmed]
PHST- 2022/02/16 06:00 [medline]
PHST- 2020/11/20 17:15 [entrez]
PHST- 2021/11/20 00:00 [pmc-release]
AID - 5996047 [pii]
AID - bkaa179 [pii]
AID - 10.1093/jat/bkaa179 [doi]
PST - ppublish
SO  - J Anal Toxicol. 2022 Feb 14;46(1):99-102. doi: 10.1093/jat/bkaa179.