Project Description Narrative:
The rising rate of unintentional pediatric cannabis ingestions in the United States has become a public health concern. Rates of THC ingestion in pediatric emergency departments have significantly increased in recent years. Many young children who unintentionally ingest cannabis present to the emergency department (ED) with varied, non-specific signs and symptoms, the most common being altered mental status (AMS). The majority of children with THC ingestion will experience a period of AMS that will improve over time with no intervention. Unfortunately, diagnosis of THC ingestion can often be delayed, as urine drug screens often take over an hour to return a result.
Given that the differential diagnosis for acute AMS includes emergent intracranial bleeding, increased intracranial pressure, encephalitis, meningitis, metabolic derangement, and other toxidromes, children with acute AMS pose a case of diagnostic urgency. ED clinicians are under pressure to rapidly diagnose these emergent conditions, because delays in treatment can lead to poor outcomes. Diagnostic evaluation for undifferentiated AMS often includes neuroimaging such as head computed tomography (CT), which carries with it the potential harm of radiation, and invasive procedures such as lumbar punctures to diagnose meningitis. In states such as Wisconsin where THC is illegal, pediatric patients are more likely to have imaging and other resource utilization.
This project seeks to establish clinical sensitivity and specificity of rapid urine THC testing as a steppingstone for the future implementation study of rapid THC testing. The researchers aim is to establish a sensitivity of ≥ 90% for rapid urine THC testing while showing the turnaround time for rapid THC urine testing is 45 minutes faster than the lab run urine drug screen. Their long-term research goal is to use implementation science to reduce excess resource utilization in patients presenting with THC ingestion. Access to reliable bedside point of care rapid THC test which can be integrated into clinical care pathways, educational modules, and providers’ report cards will form the backbone of an implementation program. Following this study, the project team intends to implement rapid urine THC testing as a new standardized protocol to improve the workup of patients that present to the ED for concerns of AMS with a high suspicion of THC ingestion as the etiology. From there, resource utilization, including advanced neuro imaging rates, and PICU admissions will be monitored during a multicentered study through the PECARN to decrease diagnostic burden and its associated potential harmful effects nationwide.