6514 Urine toxicology analysis in children – implications for safeguarding

Objectives Poisoning children is a recognised form of physical abuse and the subject of several serious case reviews.¹ Little data exists on the incidence of poisoning of children as a form of physical abuse or drug ingestion due to neglect. The objective of this study was to investigate utilisation of urine toxicology testing. We aimed to evaluate: reasons for testing proportion of positive samples use of Chain of Evidence (COE). Methods Laboratory data was obtained for children aged 0 –10 years with urine toxicology samples from January 2016 to January 2021 and medical records were reviewed. Reasons for testing, whether COE procedure was followed correctly and results of tests were recorded. When reviewing results of tests, sub analysis aimed to demonstrate whether the result was expected or an unexpected result. Finally, the proportion of samples sent for COE was evaluated following publication of local guidelines. Results 79 patients aged 0–10 years had urine samples sent at least once for toxicology testing over the 5 year period. 28 positive samples. Expected positive: 19 Unexpected positive: 9 1 child was positive for more than one drug meaning in total 8 patients had unexpected positive results in a 5-year period. These children had concerning clinical presentations. COE samples 20 of 79 tests sent COE – 25% 8 of 79 were attempted COE but the process was not completed – 10% Guideline publication September 2019: Pre-guideline – 48 samples were sent, 10 of these being COE – 21%. Post guideline – 30 samples were sent, 12 of these being COE – 40%. Conclusion Upon initial assessment clinicians may not possess all the clinical/social information. Therefore, at this stage it may be best to send all samples COE. However, this is costly and resource intensive. Point of care testing for drugs is used in some units which may help allowing for full COE procedures in select cases. Deciphering the relevance of 'trace' results is difficult due to lack of normative data, forensic hair strand testing should be considered.² Our results highlighted 8 children where unexpected drugs were present in urine this may have represented deliberate poisoning environmental exposure or accidental ingestion. although physical abuse and FII must be a consideration also neglect concerns were regularly raised where children may have accidentally ingested medications/drugs. The publication of a COE Guideline did have meaningful impact, this needs further improvement as testing rates remain low and 10% of attempted COE samples failed. Clarity on which cases would benefit from COE is needed and further training is planned.³ References https://library.nspcc.org.uk HeritageScriptsHampshireBabyZOverview.pdf 2020. Archer JR, Wood DM, Dargan PI. How to use toxicology screening tests. Archives of Disease in Childhood-Education and Practice, 2012;97(5):194–199. Dyer EM, Salehian S. How to interpret urine toxicology tests. Archives of Disease in Childhood-Education and Practice, 2020;105(2):84–88.