Dear Dr. Ortiz Guerrero,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 30 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

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We look forward to receiving your revised manuscript.

Kind regards,

David Wampler

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. We note that your Data Availability Statement is currently as follows: [All relevant data are within the manuscript and its Supporting Information files.]

Please confirm at this time whether or not your submission contains all raw data required to replicate the results of your study. Authors must share the “minimal data set” for their submission. PLOS defines the minimal data set to consist of the data required to replicate all study findings reported in the article, as well as related metadata and methods (https://journals.plos.org/plosone/s/data-availability#loc-minimal-data-set-definition).

For example, authors should submit the following data:

- The values behind the means, standard deviations and other measures reported;

- The values used to build graphs;

- The points extracted from images for analysis.

Authors do not need to submit their entire data set if only a portion of the data was used in the reported study.

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3. Please upload a new copy of Figure 3 as the detail is not clear. Please follow the link for more information: https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/ .

Additional Editor Comments:

Dear Dr. Guerrero

I would like to apologize for the delay in getting your reviewer comments. The current environment of recruiting high quality reviews has become challenging.

From the comments below, reviews are favorable and your paper has merit, and with a some significant work I would be happy to reconsider for publication in PLOS One.

I look for forward to your revision,

David Wampler, PhD

Editor

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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Reviewer #1: Reviewer comment and suggestions

Title

• The title is clear and informative, accurately reflecting the study's focus on racial disparities in urine drug screening (UDS) among patients presenting with suspected seizures.

Abstract:

• An abstract summarizing the background, methods, results, and conclusion will enhance accessibility and provide quick insight into the study’s contributions. An abstract following PLOS guidelines should also include keywords.

Introduction:

• The introduction could benefit from a more thorough literature review. Acknowledging existing studies on UDS disparities would strengthen the foundation for this research. Consider including the rationale for focusing specifically on UDS and the clinical implications of equitable access to this testing.

Methods:

• A clear description of sample selection criteria is provided, but details about exclusion criteria or specific demographic data (e.g., age ranges, comorbid conditions) would enhance reproducibility.

• Information regarding the statistical analysis might be more detailed. Indicating confidence intervals and effect sizes for the Chi-square results would provide a clearer picture of the clinical significance of the findings.

Results:

• The presentation of data is straightforward, with clear comparisons drawn between racial groups. However, including visual aids such as tables or graphs to present results (e.g., rates of UDS testing and positivity by race) could improve clarity.

• The narrative mentions UDS substance positivity but does not elaborate on the potential clinical implications of these findings, such as differences in management or treatment outcomes based on detected substances.

Discussion:

• The discussion provides a solid interpretation of findings but could incorporate broader implications of racial disparities in medical testing and treatment. Consider exploring the potential reasons for observed disparities, including systemic biases or differences in healthcare access.

• Addressing the limitations of the study, such as potential biases in retrospective data analysis or unmeasured confounders would enhance the transparency of the research.

• The conclusion reiterates the main findings but could benefit from a call to action, such as recommendations for addressing these disparities in clinical practice or suggestions for future research.

References:

• Ensure that all references are current and relevant, following PLOS guidelines for citation style. A comprehensive reference list will enhance the study's credibility.

General Formatting:

• Ensure that the manuscript follows PLOS ONE formatting guidelines, including specific font sizes, headings, and citation styles. This attention to detail is essential for submission readiness.

Ethical Considerations:

• Consider including a statement confirming institutional review board approval and patient consent where applicable.

In summary, this study addresses an important topic concerning racial disparities in UDS among patients with suspected seizures. Improvements in clarity and depth of analysis, alongside adherence to PLOS guidelines, will strengthen the manuscript's overall impact and quality.

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what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: Yes:  REHEMA ABDALLAH

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Dear Dr. Ortiz Guerrero,

Please submit your revised manuscript by Sep 29 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

David Wampler

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Guerrero,

Congratulations, with only a few minor edits I am prepared to recommend your work for publication in PLOS One. Reviewers just ask that you tighten up a few disclosures.

Again congrats, Well done.

David Wampler, PhD

Academic Editor, PLOS One

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

**********

Reviewer #1: Reviewer comment and suggestions

This article presents a retrospective analysis examining racial and ethnic disparities in urine drug screening (UDS) among patients with suspected seizures in the emergency department (ED).However some of issues need more clarifications.

Strengths of the study include:

• A sizable sample over multiple years.

• Focus on an understudied area of healthcare disparities.

• Use of objective data from electronic medical records.

Limitations include:

• Single-center design, which may limit generalizability.

• Retrospective nature, which cannot establish causality.

• Limited information on clinical rationale for ordering UDS.

• Potential confounding factors such as socioeconomic status or clinical severity were not discussed.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: Yes:  rehema abdallah

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org

Racial disparities in urine drug screening among seizure patients in the emergency department

PONE-D-24-55625R2

Dear Dr. Ortiz Guerrero,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

David Wampler

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: