Introduction: Despite the fact that illicit substance use has been associated with intracerebral hemorrhage (ICH), it is not standard care to perform a urine drug screen (UDS) on all patients presenting with stroke symptoms. We examined predictors of performing a UDS in ICH patients and possible predictors of a positive UDS of those screened.
Methods: We conducted a retrospective analysis of 180 patients diagnosed with ICH between September 2014 and November 2015. We compared demographics, clinical features including reported substance abuse and discharge disposition in the patients who received toxicology screening against those who did not. Logistic regression was performed to assess predictive factors for toxicology screening and the likelihood of a positive toxicology.
Results: We identified 180 ICH patients of whom 123 received toxicology screening on arrival. There was no significant difference in sex, age, or race between the groups. A UDS was less likely to be performed if the patient transferred from an outside institution (48% vs 68%, p=0.01). Direct presenters had higher odds of getting a UDS compared to transfer patients, (OR: 2.4, 95% CI 1.2-4.9, p=0.01). Of those screened, 38% had a positive UDS. Race and sex were not significant predictors of toxicology results while age< 65 had higher odds of a positive toxicology compared to older patients (OR:4.5, 95% CI: 1.85-10.86, p=0.0009). Although most neuroimaging parameters of the ICH did not differ based on UDS, those with hydrocephalus had greater odds of having a positive UDS (OR 3.0, 95% CI 1.3-6.8, p=0.007)
Conclusion: In our sample, we found that only two-thirds of patients received a UDS. Although transferred patients were less likely to receive screening, we did not identify other significant predictors of physician UDS ordering behavior. We found a high rate of positive UDS, particularly among younger patients, suggesting that routine drug screening should be performed in all patients with ICH.