Abstract
BackgroundPredicting the neurological sequelae of carbon monoxide poisoning (COP) has not been well studied. We investigated the independent predictors of neurological sequelae in patients with COP and combined these predictors to predict the prognosis.MethodsThis study was conducted at four hospitals in Shandong Province, China. Data were retrospectively collected from 258 patients with COP between November 1990 and October 2011. Thirty-day neurological sequelae were the primary endpoints.ResultsA lack of pupil reflex and a loss of consciousness appear to be independent predictors for neurological sequelae in patients with COP. The presence of either one had a sensitivity of 77.0% (95% confidence interval [CI]: 69.3–83.2), a specificity of 47.1% (95% CI: 38.3–56.0), positive predictive value (PPV) of 62.9% (95% CI: 55.2–70.1), and a negative predictive value (NPV) of 63.6% (95% CI: 52.6–73.4). With both predictors present, the sensitivity was 11.5% (95% CI: 6.9 to 18.3), the specificity was 99.2 (95% CI: 94.7–100.0), the PPV was 94.1% (95% CI: 69.2–99.7), and the NPV was 49.0% (95% CI: 42.5–55.5).ConclusionsThe risk for neurological sequelae apparently increased with the number of independent predictors. In patients with both predictors, the risk for neurological sequelae was 94.1%. Almost all (99.2%) patients with neither predictor had no neurological sequelae. This finding may help physicians make decisions about and dispositions for patients with COP. For patients with a higher risk, earlier treatment and more appropriate utilization of health care services, including hyperbaric oxygen, should be considered.
Highlights
Carbon monoxide poisoning (COP) results in an estimated 50,000 emergency department visits in the United States annually and is one of the leading causes of poisoning death [1]
Data were retrospectively collected from 258 patients with carbon monoxide poisoning (COP) between November 1990 and October 2011
The presence of either one had a sensitivity of 77.0% (95% confidence interval [CI]: 69.3–83.2), a specificity of 47.1%, positive predictive value (PPV) of 62.9%, and a negative
Summary
Carbon monoxide poisoning (COP) results in an estimated 50,000 emergency department visits in the United States annually and is one of the leading causes of poisoning death [1]. Because COP is commonly misdiagnosed, the true numbers are likely to be much higher [2]. The recommended treatment for acute COP is 100 percent normobaric oxygen, commonly delivered from a reservoir through a face mask that prevents rebreathing [3]. Hyperbaric-oxygen therapy is often recommended for patients with acute COP, especially if they have lost consciousness or have severe poisoning [3]. Predicting the neurological sequelae of carbon monoxide poisoning (COP) has not been well studied. We investigated the independent predictors of neurological sequelae in patients with COP and combined these predictors to predict the prognosis
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