Abstract
Objective: This study examined predictors of globus pallidus necrosis as there was a paucity of literature of globus pallidus necrosis resulted from carbon monoxide poisoning after charcoal burning suicide. Methods: A total of 67 patients who had attempted charcoal burning suicide were recruited and stratified into two subgroups based on either presence (n = 40) or absence (n = 27) of globus pallidus necrosis. Demographic, clinical, laboratory, and radiographic data were obtained for cross-sectional analysis. All patients were followed to investigate the risks for mortality. Results: The patients aged 36.8 ± 11.1 years (67.2%) were male. Patients with globus pallidus necrosis were younger (p = 0.044) and had less hypertension (p = 0.015) than patients without globus pallidus necrosis. Furthermore, patients with globus pallidus necrosis suffered from severer medical complications, i.e., fever (p = 0.008), acute myocardial injury (p = 0.022), acute rhabdomyolysis (p = 0.022), and neuropsychiatric symptoms (p < 0.001) than patients without globus pallidus necrosis. Moreover, patients with globus pallidus necrosis received less hyperbaric oxygen therapy than without necrosis (p = 0.024). Two patients (3.0%) died on arrival. In a multivariable regression model, it was revealed that acute myocardial injury (odds ratio 4.6, confidence interval 1.1–18.9, p = 0.034) and neuropsychiatric symptoms (odds ratio 8.0, confidence interval 2.0–31.4, p = 0.003), decreased blood bicarbonate level (odds ratio 0.8, confidence interval 0.7–1.0, p = 0.032), and younger age (odds ratio 0.9, confidence interval 0.9–1.0, p = 0.038) were significant predictors for globus pallidus necrosis. Conclusion: Although patients who had attempted charcoal burning suicide had a low mortality rate (3.0%), globus pallidus necrosis was not uncommon (59.7%) in this population. Further studies are warranted.
Highlights
Charcoal burning suicide is a serious public health problem in Asia
1998, but 1346 cases were noted in 2005 [1]. This endemic of charcoal burning suicide was thought to be promoted by media because this way of suicide is always described as painless and easy [2]
It was found that patients with globus pallidus necrosis were younger (34.5 ± 9.6 vs. 40.1 ± 12.4, p = 0.044) and had less hypertension
Summary
Since the first case of suicide by burning charcoal in 1998 in Hong Kong, cases have increased in many Far East areas, such as Taiwan, Japan, Korea, and China. In Taiwan, 32 people committed suicide by burning charcoal in. 1998, but 1346 cases were noted in 2005 [1] This endemic of charcoal burning suicide was thought to be promoted by media because this way of suicide is always described as painless and easy [2]. The most common brain lesion is globus pallidus necrosis [4,5]. Another study noted a hypotensive effect in the watershed territory of the arterial supply and hypoxia due to decreased arterial supplement or CO binding to globus pallidus, which is an iron-rich area [6]. Hypotension or shock status either due to sepsis, metabolic acidosis, or myocardial infarction could contribute to poorer brain perfusion
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