• Eran Kozer, Rachel Bar-Hamburger, Noa Y Rosenfeld, Irena Zdanovitch, Mordechai Bulkowstein, and Matitiahu Berkovitch.
• Pediatric Emergency Service, Assaf Harofeh Medical Center, Zerifin, Israel. erank@asaf.health.gov.il
• Isr Med Assoc J. 2008 Nov 1; 10 (11): 779-82.

BackgroundClinicians' impression of adolescents' alcohol or drug involvement may underestimate substance-related pathology.ObjectivesTo describe the characteristics of adolescents presenting to the pediatric emergency department due to substance abuse and to determine whether physicians can reliably identify these patients.MethodsWe conducted a prospective cohort study of all patients aged 12-18 years presenting to a pediatric emergency department between 1 January 2005 and 31 December 2006 for whom a urine drug screen or ethanol blood levels was ordered. According to departmental protocol, urine drug screen and ethanol levels are taken for specific indications. Based on the history and clinical findings the pediatrician in the ED assessed on a 5-point likelihood scale the possibility that the patients' symptoms were related to substance abuse.ResultsOf the 139 patients in the study group 40 (30%) tested positive for ethanol or drugs of abuse. The median age was 16. Compared with patients who tested negative, there were more patients with decreased level of consciousness among patients who tested positive for ethanol or drugs (5% vs. 33% respectively, P < 0.001). The median physician estimate for the likelihood of substance abuse was 5 in patients who tested positive and 2 in patients who tested negative (P< 0.001). The likelihood of a positive drug/ethanol test was not affected by age or gender.ConclusionsThe likelihood of substance abuse is higher in patients presenting with a low level of consciousness, Physicians may accurately assess the likelihood of substance abuse in these patients.

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