Abstract
This study aimed to retrospectively evaluate urine toxicology screening (UTS) profiles, multi-year substance use trends, and clinical correlation parameters in patients aged 0–18 years who presented to the Pediatric Emergency Department of Bursa City Hospital. Data from 100 patients who underwent UTS between January 2020 and January 2026. Toxicological analyses were performed using enzymatic immunoassay (EIA) and gas chromatography-mass spectrometry (GC-MS). Demographic analysis revealed that males accounted for 55% of the patient population, with 86% of the cohort aged between 12 and 18 years. At the analytical (exposure) threshold—which is well below conventional administrative cut-offs (e.g., cocaine >4.4 ng/mL versus a conventional administrative range of 150–300 ng/mL)—the most frequently detected substances were amphetamine (68%), cocaine (52%), and alcohol (35%). When annual positivity was expressed as a percentage of tests performed rather than as raw case counts, cocaine positivity rose sharply between 2022 and 2023 and then plateaued through 2025; this pattern reached nominal statistical significance on trend testing (Cochran–Armitage p = 0.036), though given the limited number of time points, a zero-cell year, and non-confirmation by Poisson regression, this finding should be considered exploratory and unstable rather than conclusive. Hypertension (OR = 4.20) and tachycardia (OR = 2.69) were significantly more common in patients who tested positive for cocaine. The overall rate of polysubstance use was 31%; ecstasy, opiate, cannabinoid, and alcohol use showed a strong association with this pattern. Forensic or social services reporting was completed for 83% of the cases. Substance-related admissions to pediatric emergency departments increased in parallel with expanding testing volume over the study period, with polysubstance use emerging as a particularly prominent and statistically robust concern. Emergency departments offer a critical opportunity to identify high-risk adolescents and integrate them into the social protection system. In clinical management, monitoring vital signs and electrocardiographic parameters is essential, especially when sympathomimetic substance exposure is suspected.