{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T03:03:15Z","timestamp":1779850995592,"version":"3.53.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Drug exposure in pediatric patients represents a major clinical and forensic challenge, particularly when initial urine drug screening relies on immunoassays with limited specificity. False-positive and false-negative results may lead to inappropriate clinical decisions or delayed child protection interventions. We conducted a retrospective case series of 14 pediatric patients (0\u20135\u2009years) with suspected drug exposure evaluated in a hospital emergency setting. Positive immunoassay urine drug screens were submitted for confirmatory analysis using gas chromatography\u2013mass spectrometry (GC\u2013MS) at a reference toxicology laboratory. GC\u2013MS confirmation identified a wide range of illicit and prescription substances and metabolites, including benzoylecgonine, cocaine, ecgonine methyl ester, phenobarbital, para-hydroxy-phenobarbital, lorazepam, morphine, sertraline and its metabolites, hydroxymidazolam, MDMA, MDA, and 11-nor-\u03949-tetrahydrocannabinol-9-carboxylic acid (THCCOOH). In several cases, GC\u2013MS resolved discordant screening results by identifying immunoassay false positives caused by cross-reactivity or by detecting substances missed during initial screening. Confirmatory GC\u2013MS testing directly influenced clinical management and supported child protection decisions in cases of suspected neglect, accidental ingestion, or environmental exposure. These findings reinforce the critical role of mass spectrometry-based confirmation in pediatric toxicology to ensure diagnostic accuracy and appropriate clinical and legal outcomes.<\/jats:p>","DOI":"10.1093\/jat\/bkag020","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:45:08Z","timestamp":1774010708000},"source":"Crossref","is-referenced-by-count":0,"title":["Confirmatory gas chromatography\u2013mass spectrometry drug testing in pediatric patients: a clinical case series highlighting false-positive results and child protection implications"],"prefix":"10.1093","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0980-3921","authenticated-orcid":false,"given":"Nicol\u00e1s","family":"Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Facultad de Farmacia y Bioqu\u00edmica, C\u00e1tedra de Toxicolog\u00eda y Qu\u00edmica Legal, Laboratorio de asesoramiento toxicol\u00f3gico anal\u00edtico (CENATOXA). Ciudad Aut\u00f3noma de Buenos Aires (CABA), Universidad de Buenos Aires , Buenos Aires,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Noem\u00ed","family":"Quiroga","sequence":"additional","affiliation":[{"name":"Facultad de Farmacia y Bioqu\u00edmica, C\u00e1tedra de Toxicolog\u00eda y Qu\u00edmica Legal, Laboratorio de asesoramiento toxicol\u00f3gico anal\u00edtico (CENATOXA). Ciudad Aut\u00f3noma de Buenos Aires (CABA), Universidad de Buenos Aires , Buenos Aires,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"2026052622265953700_bkag020-B1","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1080\/15563650.2022.2132768","article-title":"2021 Annual report of the National Poison Data System (NPDS) from America\u2019s Poison Centers: 39th annual report","volume":"60","author":"Gummin","year":"2022","journal-title":"Clin Toxicol (Phila)"},{"key":"2026052622265953700_bkag020-B2","doi-asserted-by":"publisher","first-page":"352","DOI":"10.3390\/jcm12010352","article-title":"Exposures and suspected intoxications to pharmacological and non-pharmacological agents in children aged 0\u201314 years: real-world data from an Italian reference poison control centre","volume":"12","author":"Brilli","year":"2023","journal-title":"J Clin Med"},{"key":"2026052622265953700_bkag020-B3","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1093\/jat\/bku075","article-title":"False-positive interferences of common urine drug screen immunoassays: a review","volume":"38","author":"Saitman","year":"2014","journal-title":"J Anal Toxicol"},{"key":"2026052622265953700_bkag020-B4","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/978-1-4939-3252-8_15","article-title":"Comprehensive urine drug screen by gas chromatography\u2013mass spectrometry (GC\u2013MS)","volume":"1383","author":"Ramoo","year":"2016","journal-title":"Methods Mol Biol"},{"key":"2026052622265953700_bkag020-B5","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1002\/dta.2547","article-title":"Optimization and validation of simultaneous analyses of ecgonine, cocaine, and seven metabolites in human urine by gas chromatography\u2013mass spectrometry using a one-step solid-phase extraction","volume":"11","author":"Fern\u00e1ndez","year":"2019","journal-title":"Drug Test Anal"},{"key":"2026052622265953700_bkag020-B6","first-page":"116","article-title":"Validaci\u00f3n de un m\u00e9todo para cuantificar \u00e1cido 11-nor-9-carboxi-\u03949-tetrahidrocannabinol en orina por cromatograf\u00eda gaseosa\u2013espectrometr\u00eda de masas previa extracci\u00f3n en fase s\u00f3lida","volume":"24","author":"Fern\u00e1ndez","year":"2016","journal-title":"Acta Toxicol Argent"},{"key":"2026052622265953700_bkag020-B7","doi-asserted-by":"publisher","first-page":"e796","DOI":"10.1542\/peds.2013-1985","article-title":"The transfer of drugs and therapeutics into human breast milk: an update on selected topics","volume":"132","author":"Sachs","year":"2013","journal-title":"Pediatrics"},{"key":"2026052622265953700_bkag020-B8","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1542\/peds.80.6.836","article-title":"Cocaine intoxication in a breast-fed infant","volume":"80","author":"Chasnoff","year":"1987","journal-title":"Pediatrics"},{"key":"2026052622265953700_bkag020-B9","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1080\/J006v16n01_09","article-title":"cocaine exposure: neurologic effects and sensory-motor delays","volume":"16","author":"Arendt","year":"1996","journal-title":"Phys Occup Ther Pediatr"},{"key":"2026052622265953700_bkag020-B10","doi-asserted-by":"publisher","first-page":"1952","DOI":"10.1001\/jama.287.15.1952","article-title":"Cognitive and motor outcomes of cocaine-exposed infants","volume":"287","author":"Singer","year":"2002","journal-title":"JAMA"},{"key":"2026052622265953700_bkag020-B11","doi-asserted-by":"publisher","first-page":"4048764","DOI":"10.1155\/2016\/4048764","article-title":"Coca: the history and medical significance of an ancient Andean tradition","volume":"2016","author":"Biondich","year":"2016","journal-title":"Emerg Med Int"},{"key":"2026052622265953700_bkag020-B12","first-page":"36","article-title":"False-positive urine screening for benzodiazepines: an association with sertraline? 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