Negative predictive value of acetaminophen concentrations within four hours of ingestion

Blake A. Froberg, Kerry J. King, Theomal D. Kurera, Andrew A. Monte, Jane M. Prosser, Steven J. Walsh, Robert H. Riffenburgh, Daniel Rusyniak, David A. Tanen

Research output: Contribution to journalArticle

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Abstract

Objectives The objective was to ascertain whether acetaminophen (APAP) concentrations less than 100 μg/mL obtained between 1 and 4 hours after acute ingestion accurately predict a nontoxic 4-hour concentration. Methods The authors performed a multicenter, prospective cohort study involving five emergency departments (EDs) participating in the ToxIC Research Network. Data were collected from May 2009 to December 2011. Patients with APAP concentrations <100 μg/mL drawn between 1 and 4 hours after acute ingestions, and concentrations drawn 4 or more hours after ingestions, were included in the study. Exclusion criteria included initial concentration >100 μg/mL, initial APAP concentration drawn prior to 1 hour, two undetectable APAP concentrations, the second concentration drawn prior to 4 hours, and unknown time of ingestion. Toxic concentrations 4 or more hours after ingestion were defined as concentrations that plotted above the 150 μg/mL line on the Rumack-Matthew nomogram. Results Data were collected on 83 patients who met inclusion criteria. Of the 83 patients with APAP concentrations <100 μg/mL between 1 and 4 hours, one patient (1.2%) had a ≥ 4-hour toxic concentration. Negative predictive value (NPV) for an APAP concentration <100 μg/mL obtained between 1 and 4 hours after an acute ingestion was 98.8% (95% confidence interval [CI] = 93.5% to 99.8%). Conclusions An APAP concentration of <100 μg/mL obtained between 1 and 4 hours after ingestion has a high NPV for excluding toxic ingestion. We do not recommend reliance on concentrations obtained between 1 and 4 hours to exclude toxicity, because of a potential false-negative rate of 6.5%.

Original languageEnglish
Pages (from-to)1072-1075
Number of pages4
JournalAcademic Emergency Medicine
Volume20
Issue number10
DOIs
StatePublished - Oct 2013

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Acetaminophen
Eating
Poisons
Nomograms
Hospital Emergency Service
Cohort Studies
Prospective Studies
Confidence Intervals
Research

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Froberg, B. A., King, K. J., Kurera, T. D., Monte, A. A., Prosser, J. M., Walsh, S. J., ... Tanen, D. A. (2013). Negative predictive value of acetaminophen concentrations within four hours of ingestion. Academic Emergency Medicine, 20(10), 1072-1075. https://doi.org/10.1111/acem.12222

Negative predictive value of acetaminophen concentrations within four hours of ingestion. / Froberg, Blake A.; King, Kerry J.; Kurera, Theomal D.; Monte, Andrew A.; Prosser, Jane M.; Walsh, Steven J.; Riffenburgh, Robert H.; Rusyniak, Daniel; Tanen, David A.

In: Academic Emergency Medicine, Vol. 20, No. 10, 10.2013, p. 1072-1075.

Research output: Contribution to journalArticle

Froberg, BA, King, KJ, Kurera, TD, Monte, AA, Prosser, JM, Walsh, SJ, Riffenburgh, RH, Rusyniak, D & Tanen, DA 2013, 'Negative predictive value of acetaminophen concentrations within four hours of ingestion', Academic Emergency Medicine, vol. 20, no. 10, pp. 1072-1075. https://doi.org/10.1111/acem.12222
Froberg BA, King KJ, Kurera TD, Monte AA, Prosser JM, Walsh SJ et al. Negative predictive value of acetaminophen concentrations within four hours of ingestion. Academic Emergency Medicine. 2013 Oct;20(10):1072-1075. https://doi.org/10.1111/acem.12222
Froberg, Blake A. ; King, Kerry J. ; Kurera, Theomal D. ; Monte, Andrew A. ; Prosser, Jane M. ; Walsh, Steven J. ; Riffenburgh, Robert H. ; Rusyniak, Daniel ; Tanen, David A. / Negative predictive value of acetaminophen concentrations within four hours of ingestion. In: Academic Emergency Medicine. 2013 ; Vol. 20, No. 10. pp. 1072-1075.
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abstract = "Objectives The objective was to ascertain whether acetaminophen (APAP) concentrations less than 100 μg/mL obtained between 1 and 4 hours after acute ingestion accurately predict a nontoxic 4-hour concentration. Methods The authors performed a multicenter, prospective cohort study involving five emergency departments (EDs) participating in the ToxIC Research Network. Data were collected from May 2009 to December 2011. Patients with APAP concentrations <100 μg/mL drawn between 1 and 4 hours after acute ingestions, and concentrations drawn 4 or more hours after ingestions, were included in the study. Exclusion criteria included initial concentration >100 μg/mL, initial APAP concentration drawn prior to 1 hour, two undetectable APAP concentrations, the second concentration drawn prior to 4 hours, and unknown time of ingestion. Toxic concentrations 4 or more hours after ingestion were defined as concentrations that plotted above the 150 μg/mL line on the Rumack-Matthew nomogram. Results Data were collected on 83 patients who met inclusion criteria. Of the 83 patients with APAP concentrations <100 μg/mL between 1 and 4 hours, one patient (1.2{\%}) had a ≥ 4-hour toxic concentration. Negative predictive value (NPV) for an APAP concentration <100 μg/mL obtained between 1 and 4 hours after an acute ingestion was 98.8{\%} (95{\%} confidence interval [CI] = 93.5{\%} to 99.8{\%}). Conclusions An APAP concentration of <100 μg/mL obtained between 1 and 4 hours after ingestion has a high NPV for excluding toxic ingestion. We do not recommend reliance on concentrations obtained between 1 and 4 hours to exclude toxicity, because of a potential false-negative rate of 6.5{\%}.",
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AU - Monte, Andrew A.

AU - Prosser, Jane M.

AU - Walsh, Steven J.

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AU - Rusyniak, Daniel

AU - Tanen, David A.

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N2 - Objectives The objective was to ascertain whether acetaminophen (APAP) concentrations less than 100 μg/mL obtained between 1 and 4 hours after acute ingestion accurately predict a nontoxic 4-hour concentration. Methods The authors performed a multicenter, prospective cohort study involving five emergency departments (EDs) participating in the ToxIC Research Network. Data were collected from May 2009 to December 2011. Patients with APAP concentrations <100 μg/mL drawn between 1 and 4 hours after acute ingestions, and concentrations drawn 4 or more hours after ingestions, were included in the study. Exclusion criteria included initial concentration >100 μg/mL, initial APAP concentration drawn prior to 1 hour, two undetectable APAP concentrations, the second concentration drawn prior to 4 hours, and unknown time of ingestion. Toxic concentrations 4 or more hours after ingestion were defined as concentrations that plotted above the 150 μg/mL line on the Rumack-Matthew nomogram. Results Data were collected on 83 patients who met inclusion criteria. Of the 83 patients with APAP concentrations <100 μg/mL between 1 and 4 hours, one patient (1.2%) had a ≥ 4-hour toxic concentration. Negative predictive value (NPV) for an APAP concentration <100 μg/mL obtained between 1 and 4 hours after an acute ingestion was 98.8% (95% confidence interval [CI] = 93.5% to 99.8%). Conclusions An APAP concentration of <100 μg/mL obtained between 1 and 4 hours after ingestion has a high NPV for excluding toxic ingestion. We do not recommend reliance on concentrations obtained between 1 and 4 hours to exclude toxicity, because of a potential false-negative rate of 6.5%.

AB - Objectives The objective was to ascertain whether acetaminophen (APAP) concentrations less than 100 μg/mL obtained between 1 and 4 hours after acute ingestion accurately predict a nontoxic 4-hour concentration. Methods The authors performed a multicenter, prospective cohort study involving five emergency departments (EDs) participating in the ToxIC Research Network. Data were collected from May 2009 to December 2011. Patients with APAP concentrations <100 μg/mL drawn between 1 and 4 hours after acute ingestions, and concentrations drawn 4 or more hours after ingestions, were included in the study. Exclusion criteria included initial concentration >100 μg/mL, initial APAP concentration drawn prior to 1 hour, two undetectable APAP concentrations, the second concentration drawn prior to 4 hours, and unknown time of ingestion. Toxic concentrations 4 or more hours after ingestion were defined as concentrations that plotted above the 150 μg/mL line on the Rumack-Matthew nomogram. Results Data were collected on 83 patients who met inclusion criteria. Of the 83 patients with APAP concentrations <100 μg/mL between 1 and 4 hours, one patient (1.2%) had a ≥ 4-hour toxic concentration. Negative predictive value (NPV) for an APAP concentration <100 μg/mL obtained between 1 and 4 hours after an acute ingestion was 98.8% (95% confidence interval [CI] = 93.5% to 99.8%). Conclusions An APAP concentration of <100 μg/mL obtained between 1 and 4 hours after ingestion has a high NPV for excluding toxic ingestion. We do not recommend reliance on concentrations obtained between 1 and 4 hours to exclude toxicity, because of a potential false-negative rate of 6.5%.

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