Citation

Kim YJ, Sohn CH, Seo DW, Oh BJ, Lim KS, Kim WY. Acad. Emerg. Med. 2019; 26(1): 60-67.

Affiliation

Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Copyright

(Copyright © 2019, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/acem.13510

PMID

29953694

Abstract

OBJECTIVES: Objective screening tool for patients at a high risk of developing acute brain injury (ABI) is necessary for the proper treatment of carbon monoxide (CO) poisoning patients. The aim of this study is to identify clinical factors that could predict ABI due to CO poisoning in patients with an altered mental status.

METHODS: A prospectively collected CO poisoning registry at a single academic medical center was retrospectively analyzed. CO poisoning patients with an altered mental status at the emergency department, defined as unalert on the Alert/responsive to Voice/responsive to Pain/Unresponsive scale, and underwent diffusion-weighted magnetic resonance imaging (DW-MRI) between January 1, 2013, and December 31, 2015, were included. ABI was defined as the presence of acute hypoxic brain lesions. Clinical predictors of ABI were identified by multivariate logistic regression analysis.

RESULTS: Of 180 patients, 67 (37.2%) had ABI as revealed by DW-MRI. Multivariate analysis showed that CO exposure duration > 5 hours (AOR [adjusted odds ratio], 7.082; 95% confidence interval [CI], 3.463-15.014; P<.001) defined as the time between CO exposure and rescue, abnormal WBC count (AOR, 2.568; 95% CI, 1.188-5.700; P=.02), and abnormal creatinine concentration (AOR, 2.667; 95% CI, 1.110-6.605; P=.03) were predictors of ABI. CO exposure duration had the highest predictive value (area under the curve, 0.815), and the optimal cutoff value was 5 hours. Moreover, increasing exposure durations (quartile) indicated a stepwise increase in the risk of ABI.

CONCLUSIONS: In CO poisoning patients with an altered mental status, CO exposure duration was useful for predicting ABI, which may help clinicians or paramedics identify high-risk patients and provide treatment on priority. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

Carbon monoxide poisoning; altered mental status; brain injury; diffusion-weighted magnetic resonance imaging; exposure duration