New research from King's College London suggests that a rapid blood testing method could deliver reliable results far more quickly than previously thought, potentially supporting faster and more accurate decision-making in emergency departments.
Acute recreational drug toxicity is a common reason for attendance at emergency departments. However, confirmatory laboratory testing to identify the drugs involved is rarely available in real time. Instead, clinicians often rely on patients' self-reported drug use and their clinical symptoms, which can be unreliable when patients are confused, drowsy, or unaware of the substances they have taken.
The new research published in Analyst, explored whether a laboratory technique known as paper spray ionisation mass spectrometry (PSI-MS) could be adapted for faster use in clinical settings. PSI-MS allows drugs to be detected directly from a small drop of blood dried onto paper, removing the need for lengthy sample preparation or complex laboratory processes. Until now, samples typically needed to dry for at least 60 minutes before analysis, limiting the technique's usefulness in urgent care.
Researchers investigated whether much shorter drying times could still produce accurate and reliable results. They tested whole blood samples containing ten common drugs of abuse, comparing samples dried for 10, 20, 40 and 60 minutes. These were analysed using PSI-MS and assessed for accuracy, consistency and reliability.
The findings showed that blood spots dried for as little as 10 minutes performed just as well as those dried for a full hour. Across all drying times, the results were consistent and precise, and the technique reliably identified each drug. Importantly, shortening the drying time did not affect the performance of the mass spectrometry equipment.
This means that confirmatory toxicology results could potentially be available within around 15 minutes of blood sample collection, a significant improvement compared with existing laboratory approaches. Faster access to reliable drug identification could help clinicians tailor treatment more effectively and improve patient safety.
In drug-related emergencies, clinicians are often forced to act with limited or unreliable information. Our results show that rapid mass spectrometry testing could provide dependable drug identification in a clinically meaningful timeframe, with clear potential to improve patient safety in acute settings.
Senior author Dr Vincenzo Abbate, Reader in Bioanalysis in the School of Cancer & Pharmaceutical Sciences at King's College London
At present, liquid chromatography-tandem mass spectrometry is considered the gold standard for toxicology testing due to its high sensitivity and selectivity, however it is time-consuming, resource-intensive and rarely accessible in emergency settings. By contrast, PSI-MS doesn't require extra chemicals, complicated preparation steps, or specialised lab facilities, so it's easier for hospitals to use as part of everyday clinical care.
While further research is needed before the approach can be implemented clinically, the research highlights a promising step towards faster drug toxicology testing in emergency care.
