Abstract
We aimed to assess the evidence regarding the usefulness of brain imaging as a diagnostic tool for delayed neurological sequelae (DNS) in patients with acute carbon monoxide poisoning (COP). Observational studies that included adult patients with COP and DNS were retrieved from Embase, MEDLINE, and Cochrane Library databases in December 2020 and pooled using a random-effects model. Seventeen studies were systematically reviewed. Eight and seven studies on magnetic resonance imaging (MRI) and computed tomography (CT), respectively, underwent meta-analysis. The pooled sensitivity and specificity of MRI for diagnosis of DNS were 70.9% (95% confidence interval [CI] 64.8–76.3%, I2 = 0%) and 84.2% (95% CI 80.1–87.6%, I2 = 63%), respectively. The pooled sensitivity and specificity of CT were 72.9% (95% CI 62.5–81.3%, I2 = 8%) and 78.2% (95% CI 74.4–87.1%, I2 = 91%), respectively. The areas under the curve for MRI and CT were 0.81 (standard error, 0.08; Q* = 0.74) and 0.80 (standard error, 0.05, Q* = 0.74), respectively. The results indicate that detecting abnormal brain lesions using MRI or CT may assist in diagnosing DNS in acute COP patients.
Highlights
Carbon monoxide poisoning (COP) is a leading cause of poisoning-related mortality worldwide[1]
Liao et al showed that QT prolongation on electrocardiogram combined with loss of consciousness (LOC) and a low Glasgow Coma Scale (GCS) score was associated with the occurrence of DNS8
We evaluated the usefulness of neuroimaging to diagnose delayed neurological sequelae (DNS) in patients with COP who experienced lucid periods of improved acute poisoning symptoms, excluding patients with persistent neurological symptoms after COP
Summary
Carbon monoxide poisoning (COP) is a leading cause of poisoning-related mortality worldwide[1]. If clinical information related to poisoning cannot be assessed due to, for example, an altered mental state, COP may be missed or the diagnosis may be delayed. After the onset of acute COP symptoms, some patients may develop delayed neurological sequelae (DNS) 2–40 days after CO exposure[3–5]. Lesions caused by COP can be identified through brain imaging examinations during the acute poisoning phase. Magnetic resonance imaging (MRI) can sensitively recognize COP-related cytotoxic edema when performed within 72 h after exposure to CO16, demonstrating the possibility of diagnosing DNS in an early phase. We aimed to identify studies that performed brain imaging examinations of patients during the acute phase of COP and use meta-analysis to determine the possibility of DNS diagnosis by abnormal lesions in early computed tomography (CT) and MRI
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