Is urinary toxicology rapid screening a useful first-line diagnostic tool for paediatric coma in the emergency department?

Introduction: Coma in paediatric patients is a medical emergency requiring prompt identification of the underlying cause to prevent serious complications. Among the most frequent and often underrecognized causes in young children are accidental ingestions of cannabinoids and opioids, which may go unreported by caregivers either because unwitnessed or for lack of awareness of the potential risks. In this context, rapid urine screening (RUS) is a highly valuable diagnostic tool: it is inexpensive, quick, easy to perform, and sensitive to many common neurotoxic substances. In this study, we systematically reviewed the available literature on Medline regarding paediatric patients with intoxication-induced coma presenting to the emergency department. Methods: A systematic review of the literature was performed in PubMed. Results: 32 case reports encompassing 57 paediatric cases were identified. Urine screening enabled identification of the toxic agent in approximately two-thirds of patients (20 RUS), helping guide early therapeutic decisions. Although qualitative and not always reflective of the severity of intoxication, RUS remains effective in the initial clinical assessment. However, RUS is not considered as a potentially useful early investigation, to be performed after glucose level and blood tests, before other procedures such as CT scan, lumbar puncture or EEG, in most paediatric guidelines. Discussion: The available epidemiological evidence of the last few years suggests that routine implementation of RUS in children under 4 years of age presenting with altered consciousness may reduce the need for invasive procedures such as lumbar puncture or computed tomography scan and support timely, targeted management.