当面对与毒品有关的死亡人数增加和法医病理学家的减少时,为了适当地对病例进行分诊并加快周转时间,显然需要迅速确定毒理学相关死亡.尸检前进行的侧流免疫测定可在几分钟内提供快速的尿液药物筛查(UDS)结果,并用于告知尸检的需要。对1000多例法医学病例进行了审查,以将UDS结果与实验室酶联免疫吸附测定(ELISA)血液结果进行比较,以评估尸检UDS对实验室结果的预测。对ELISA阳性标本进行质谱分析,并在可能的情况下将这些数据用于研究UDS假阴性(FN)结果。五种不同的UDS设备(STATOneStepDrugofAbusedipcardandbards,PremiereBiotech多种药物和芬太尼浸渍卡和ATTEST6-乙酰吗啡(6-AM)浸渍卡)进行了测试,包括11种药物类别:6-AM,苯丙胺/甲基苯丙胺,苯二氮卓类药物,苯甲酰基芽子碱,芬太尼,美沙酮,阿片类药物,苯环利定,和δ-9-四氢大麻酚。灵敏度,特异性,效率,阳性和阴性预测值>80%表明UDS可用于预测涉及苯甲酰孕酮的病例,美沙酮,甲基苯丙胺,和苯环利定.UDS在预测苯丙胺方面不可靠,苯二氮卓类药物,芬太尼,和阿片类药物相关的案件,由于高百分比的FN(高达11.2%,8.0%,12.4%,和5.5%,分别)与ELISA血液结果进行比较。对于后来的分析物,敏感性低至57.5%,60.0%,72.2%,和66.7%,分别。总体结果支持UDS不能取代实验室测试。由于UDS受到假阳性和FN结果的影响,用户必须了解使用UDS进行分类或决策的局限性。
When faced with increasing drug-related deaths and decline in practicing forensic pathologists, the need to quickly identify toxicology-related deaths is evident in order to appropriately triage cases and expedite turnaround times. Lateral flow immunoassays conducted pre-autopsy offer quick urine drug screen (UDS) results in minutes and are used to inform the need for autopsy. Over 1000 medicolegal cases were reviewed to compare UDS results to laboratory enzyme-linked immunosorbent assay (ELISA) blood results to evaluate how well autopsy UDS predicted laboratory findings. Mass spectral analysis was performed on ELISA-positive specimens and these data were used to investigate UDS false-negative (FN) results when possible. Five different UDS devices (STAT One Step Drug of Abuse dip card and cassette, Premiere Biotech multi-drug and fentanyl dip cards and ATTEST 6-acetylmorphine (6-AM) dip card) were tested encompassing 11 drug classes: 6-AM, amphetamine/methamphetamine, benzodiazepines, benzoylecgonine, fentanyl, methadone, opioids, phencyclidine, and delta-9-tetrahydrocannabinol. Sensitivity, specificity, efficiency, and positive and negative predictive values >80% indicated that UDS was useful for predicting cases involving benzoylecgonine, methadone, methamphetamine, and phencyclidine. UDS was unreliable in predicting amphetamine, benzodiazepines, fentanyl, and opiates-related cases due to a high percentage of FN (up to 11.2%, 8.0%, 12.4%, and 5.5%, respectively) when compared to ELISA blood results. For the later analytes, sensitivities were as low as 57.5%, 60.0%, 72.2%, and 66.7%, respectively. Overall results support that UDS cannot replace laboratory testing. Because UDS is subject to false-positive and FN results users must understand the limitations of using UDS for triage or decision-making purposes.