TOPLINE:

A new study showed that drug screen results for children presenting to emergency departments (EDs) with cannabis poisoning were often delayed, and their initial complaints influenced the use of neuroimaging. The study highlights the need to expedite toxicology screening to reduce unnecessary scans.

METHODOLOGY:

• Researchers analyzed 3653 ED visits from 2016 to 2024 for children younger than 6 years with a cannabis poisoning diagnosis and a documented urine cannabinoid test from Epic's Cosmos database.
• The median age of patients was 29 months, with 51% girls and 41% White individuals. Most visits occurred in general EDs (80%), and 20% occurred in pediatric centers.
• Patients were grouped on the basis of chief complaints: neurologic‐only (n = 1540), exposure‐only (n = 1203), combined neurologic-exposure (n = 55), and other complaints (n = 450).
• The researchers characterized the clinical presentation of children with cannabis poisoning in the ED, evaluated the timing of urine drug screen results, and examined the relationship between presenting chief complaints and the use of diagnostic neuroimaging (CT or MRI).

TAKEAWAY:

• Children with cannabis poisoning in the ED were generally triaged as high acuity (60% at Emergency Severity Index level 2) and most commonly presented with altered mental status (39%), ingestion/exposure (35%), and seizures or abnormal movements (5%), whereas other complaints — such as trauma, screening, and alleged abuse — were uncommon.
• The median time to cannabis test collection was 93 minutes, and the median time to the first test result was 152 minutes. In 19% of visits, results were received after patient disposition.
• The neurologic-only group had median times of 72 minutes to cannabis test collection and 132 minutes to result, with 56% receiving neuroimaging (reference group). The exposure-only group had 127 and 188 minutes, with 8.8% receiving neuroimaging (odds ratio [OR], 0.08; 95% CI, 0.06-0.10), and the combined group had 47 and 120 minutes, with 24% receiving neuroimaging (OR, 0.25; 95% CI, 0.13-0.45).
• Neuroimaging occurred in 35% of visits, with similar rates in general and pediatric EDs (35% vs 36%; P = .6).

IN PRACTICE:

"We found that encounters were generally high acuity, with chief complaints primarily related to ingestion or neurologic symptoms. Drug screen results were frequently unavailable until late in ED visits, and presenting chief complaint strongly influenced the use of advanced neuroimaging," the authors wrote.

"These findings underscore the need for strategies to promote early caregiver disclosure of ingestion, expedite drug screening results, and reduce low-yield imaging to optimize care and resource use for these children," they added.

SOURCE:

The study was led by Patrick Walsh, MD, MS, Medical College of Wisconsin, Milwaukee, Wisconsin. It was published online on August 8, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

The Epic Cosmos database had limitations as results were available only for common laboratory tests, potentially introducing a selection bias. Chief complaint documentation was incomplete in some cases. The timing data were limited to laboratory testing, with no timestamps available for imaging results. Initial ED visits and incoming transfers could not be reliably distinguished, and measures of testing delays and imaging use may have been confounded by prior evaluation at referring facilities.

DISCLOSURES:

No funding information was provided in the study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.