Objective:

To determine the relationship between race and urine drug screen (UDS) ordering in patients evaluated in the Emergency Department (ED) with altered mental status (AMS) or encephalopathy.

Background:

Many patients visit the ED for AMS and encephalopathy, and urine drug screens (UDS) are often obtained to evaluate for substance use as an etiology. In our review of literature, there are no studies investigating racial differences in UDS performance for patients with AMS or encephalopathy in the ED.

Design/Methods:

A retrospective review of patients ≥18 years of age diagnosed with AMS or encephalopathy in the ED between January 25, 2022 and December 31, 2021 was conducted. The relationship between race and ordering of UDS was explored using the Chi-square or Fisher’s Exact test. Significance was assessed at p<0.05.

Results:

The review included 293 patients, average age 58.5+20.9 years with 52.6% (154) males and 47.4% (139) females. UDS were ordered more frequently for Hispanics (50.0%; 8/16) and African-Americans (46.6%; 34/73) compared to Caucasians (34.3%; 68/198) though not a significant finding (p=0.093). Overall, there was no significant difference in the percentage of positive UDS results among racial groups: Hispanic (66.7%; 4/6), African-American (60%; 15/25), and Caucasian (52.8%; 28/53), p=0.726. Among the individuals who did not have a history of substance use, there was a significant difference with UDS being ordered more frequently for Hispanic (50.0%; 3/6) and African-American (44.7%; 21/47) groups compared to Caucasian (23.1%; 34/147), Asian (0.0%; 0/4), and American-Indian or Alaskan Native (0.0%, 0/2) patients (p=0.014).

Conclusions:

Our single-institution study revealed disproportionate UDS ordering among races. Further exploration into racial disparities in obtaining UDS for patients presenting to the ED with AMS or encephalopathy is warranted.