By Vrajesh Pandya, PhD, DABCC, FADLM
Toxicology testing for emergency departments (ED) has long been a cornerstone for many hospital-based laboratories. However, as the drug landscape has shifted dramatically over the past 2 decades, many labs are still relying on outdated protocols. That disconnect was the focus of the session, “ADLM Guidance on Emergency Department Toxicology Testing: Impact on Your Laboratory.”
The session brought together experts to discuss two anticipated Association for Diagnostics & Laboratory Medicine (ADLM) guidelines for ED toxicology testing, which are expected to be released later this year — guidance that many in the field have been awaiting eagerly.
Stacy Melanson, MD, PhD, vice chair of clinical laboratories at Brigham and Women’s Hospital and a member of the emergency toxicology (substance use) guideline committee, focused her talk on the recommended test menu, best practices for results reporting, and the limitations of current testing methods. “Many healthcare providers lack knowledge on limitations of immunoassays — performed either in the lab or at the point of care — to screen for drugs of misuse, and how to interpret results is a gap,” Melanson noted. She also pointed to the need for better technology and alternative sample types, such as oral fluid or serum, to support more accurate and rapid testing in emergency settings.
Melanson traced the rise of novel psychoactive substances and the challenges they pose for drug screening. She concluded with a practical checklist designed to help labs implement the upcoming guidelines in a structured and efficient way.
Patrick Kyle, PhD, professor of pathology at the University of Mississippi and a co-chair of the emergency toxicology (general toxicology) guideline development committee, opened his talk by surveying the current state of toxicology testing. “The current toxicology testing landscape may have gaps involving outdated protocols, assays, or algorithms,” Kyle said. “This is an ideal time to publish updated recommendations because the drug landscape and the instrumentation available to laboratories have changed dramatically in the past ten years.”
Kyle walked attendees through the importance of timely toxicology testing, highlighting the most common agents involved in pediatric and adult toxic exposures. He then introduced the committee’s primary (Tier I) and secondary (Tier II) test recommendations, using clinical case studies to illustrate how technologies like mass spectrometry can be used to improve accuracy. His presentation aimed to equip laboratories with a clearer understanding of best practices and tools best suited to meet their communities’ needs.
Bringing a clinical perspective to the discussion, Trevonne Thompson, MD, an ED physician and medical toxicologist at the University of Illinois College of Medicine, shared several case studies that underscored the importance of collaboration between clinicians and laboratorians. His examples illustrated how such partnerships can be critical in identifying toxic exposures and guiding treatment decisions.
Moderating the session was Christine Snozek, PhD, who emphasized the broader goal of the new documents: “I think we’re hoping these documents inspire labs to look at their current practices in support of the emergency department and critically evaluate whether they are in line with present-day needs.”
With these updated guidelines, ADLM hopes to bring clarity and consistency to a field that has long been in flux — ensuring that toxicology testing in emergency departments is both current and clinically meaningful.
