Test for Illicit Drugs in Children Evaluated for Abuse or Neglect

In 2004, the University of Iowa hospitals and clinics implemented a clinical practice guideline for illicit drug testing in children (age, <18 years) evaluated for suspected abuse who met at least one of the following criteria: family history of domestic violence, parental history of substance abuse, age <2 years, or burns or unusual injuries. To identify factors associated with positive drug test results, researchers reviewed the charts of 572 children who were evaluated for suspected maltreatment from 2004 to 2008.

Of 232 patients (41%) who were tested for illicit drugs, 34 (15%) had positive test results; half the children with positive test results had drugs detected in hair samples, indicating multiple exposures in the course of at least 1 week and up to several months. Evidence of long-term maltreatment was significantly more common in patients with positive drug test results than in those with negative test results (79% vs. 52%). In logistic regression analysis, factors significantly associated with positive drug test results were physical abuse or neglect (odds ratio, 6.7), public or no health insurance (OR, 4.5), history of parental drug abuse (OR, 3.4), and history of domestic violence in the family (OR, 2.8).