Reducing the need for repeating urine drug testing with the gray zone determined by the measurement uncertainty

Abstract

Background: On an initial urine screening test for illegal substances, if the concentration of a substance is at or above the determined legislative threshold, it is reported as positive. Repeating testing with the same sample to verify it before reporting is a common practice in clinical laboratories. This study aimed to determine whether measurement uncertainty (MU) results can be used to detect a grey zone to reduce repeat testing. Methods: A retrospective study was conducted using data from the laboratory information system between January 1, 2020, and July 1, 2022. Samples studied twice within one hour before reporting for the same urine sample were analyzed. The MU values for urinary amphetamine, cannabinoid, cocaine, and opioid parameters were calculated using ADVIA Chemistry reagents on a Siemens ADVIA 1800 chemical analyzer. The grey zone was defined as the cut-off value ± MU. Results: Urine samples, 319 amphetamine, 198 cannabinoid, 112 cocaine, and 125 opiate tests were repeated from 31.839 patients (16-65 years). Ten amphetamine, 12 can - nabinoid and 2 cocaine test results changed from positive to negative or negative to positive on retesting, all within the grey zone level defined by the MU value. Mean biases bet - ween the repeated test results were -7.64 (95% CI: -13.71 to -1.57) ng/mL for the amphetamine and 1.16 (95% CI: 0.31 to 2.01) ng/mL for the cannabinoid results. Conclusion: Repeating only values within the grey area for each illicit substance may be useful to reduce unnecessary duplicate measurements.

Keywords

• cut-off
• grey zone
• measurement uncertainty
• amphetamine
• cannabinoid
• cocaine