Clinical utility of urine drug screening in children younger than 7 years in the pediatric emergency department: a multicenter retrospective study.

BACKGROUND: Urine drug screening (UDS) is an immunoassay frequently used in emergency departments to detect drug exposure; however, its clinical utility remains debated. This study aimed to describe the clinical and epidemiological characteristics of young children who underwent UDS and to assess whether the test results influenced case management. METHODS: We conducted a multicenter retrospective chart review across four hospitals, including children younger than 7 years who underwent UDS between 2010 and 2023. RESULTS: Among the 693 patients (mean age, 30.7 ± 19.4 months; 59.1% male), 115 UDS tests were positive. In 36 patients (5.2%), the UDS contributed to establishing the diagnosis. Tetrahydrocannabinol (THC) was the most common substance identified in these cases. Hospitalization was more common in the UDS-established diagnosis group (33/36, 91.7% vs. 494/657, 75.2%; P = 0.026), and involvement in child protective services was also more common (26/36, 72.2% vs. 53/657, 8.1%; P < 0.001). The hospitalization duration was shorter in these patients (2.6 ± 2.1 vs. 4.2 ± 6.4 days; P = 0.002), and electroencephalography was performed less often (4/36, 11.1% vs. 229/655, 35.0%; P = 0.003). CONCLUSIONS: UDS influences the diagnosis and management of approximately 5% of young children, most commonly when THC is detected. Further studies are needed to refine the role of UDS in the pediatric emergency department.