Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine resuscitation and emergency medicine, 2011-03, Vol.19 (1), p.16-16, Article 16
• Main Authors: Pepe, Giuseppe, Castelli, Matteo, Nazerian, Peiman, Vanni, Simone, Del Panta, Massimo, Gambassi, Francesco, Botti, Primo, Missanelli, Andrea, Grifoni, Stefano
• Format: Article
• Language: English
• Subjects: Acidosis; Adult; Age; Algorithms; Blood pressure; Carbon monoxide; Carbon monoxide poisoning; Carbon Monoxide Poisoning - physiopathology; Carbon Monoxide Poisoning - therapy; Carboxyhemoglobin; Care and treatment; Coma; Complications; Consciousness; Convulsions & seizures; Creatine kinase; Data processing; Disease Progression; Dyspnea; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Emergency services; Enzymes; Fainting; Headache; Headaches; Health aspects; Hospitals; Humans; Hyperbaric oxygen therapy; Hyperbaric Oxygenation; Ischemia; Italy; Lactic acid; Leukocytosis; Male; Mental Disorders - chemically induced; Mental Disorders - diagnosis; Mental Disorders - prevention & control; Metabolism; Multivariate analysis; Nervous System Diseases - chemically induced; Nervous System Diseases - diagnosis; Nervous System Diseases - prevention & control; Neuropsychological Tests; Neuropsychology; Original Research; Oxygen therapy; Patients; Poisoning; Retrospective Studies; Risk Assessment - methods; Risk factors; Seizures; Sex; Statistical analysis; Student's t-test; Trauma; Variables; Variance analysis
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/1757-7241-19-16

Delayed neuropsychological sequelae (DNS) commonly occur after recovery from acute carbon monoxide (CO) poisoning. The preventive role and the indications for hyperbaric oxygen therapy in the acute setting are still controversial. Early identification of patients at risk in the Emergency Department might permit an improvement in quality of care. We conducted a retrospective study to identify predictive risk factors for DNS development in the Emergency Department. We retrospectively considered all CO-poisoned patients admitted to the Emergency Department of Careggi University General Hospital (Florence, Italy) from 1992 to 2007. Patients were invited to participate in three follow-up visits at one, six and twelve months from hospital discharge. Clinical and biohumoral data were collected; univariate and multivariate analysis were performed to identify predictive risk factors for DNS. Three hundred forty seven patients were admitted to the Emergency Department for acute CO poisoning from 1992 to 2007; 141/347 patients participated in the follow-up visit at one month from hospital discharge. Thirty four/141 patients were diagnosed with DNS (24.1%). Five/34 patients previously diagnosed as having DNS presented to the follow-up visit at six months, reporting a complete recovery. The following variables (collected before or upon Emergency Department admission) were associated to DNS development at one month from hospital discharge in the univariate analysis: CO exposure duration >6 hours, a Glasgow Coma Scale (GCS) score