Urine drugs of abuse testing at the point-of-care: clinical interpretationand programmatic considerations with specific reference to the Syva Rapid Test (SRT)

We evaluated a new point-of-care (POC) device for urine drugs of abuse (DOA ) screening including appropriate clinical interpretation and potential ben efits in a large academic medical center. Two hundred consecutive urine sam ples were tested using Syva Rapid Test (SRT) and existing laboratory method s (Syva EMIT II). Agreement between methods was acceptable with some consid erations. Threshold concentration differences, drug interferences, and cros s-reactivity profiles of the class-specific assays resulted in performance differences between the POC and central laboratory methods. Clinical interp retation of POC results requires an understanding of these issues as well a s the limitations of urine testing. While urine-based screening is used in workplace testing and in a variety of clinical applications, quantitative b lood measurements of some drugs (e.g. ethanol, acetaminophen, salicylate, /-tricyclic antidepressants) will remain important in the emergent setting. Performance of the SRT method takes approximately 10 min. Consequently, th e major advantage over laboratory methods is rapid turnaround time. At the Massachusetts General Hospital, the most important application is for sampl es from the emergency department (about 1700/year). Each institution should assess its own needs and capabilities with regard to POC versus laboratory -based testing for DOA. (C) 2001 Published by Elsevier Science B.V.