Predictors for Delayed Encephalopathy Following Acute Carbon Monoxide Poisoning

Kaoru Kudo; Kotaro Otsuka; Junko Yagi; Katsumi Sanjo; Noritaka Koizumi; Atsuhiko Koeda; Miki Yokota Umetsu; Yasuhito Yoshioka; Ayumi Mizugai; Toshinari Mita; Yu Shiga; Fumito Koizumi; Hikaru Nakamura; Akio Sakai


BMC Emerg Med. 2014;14(3) 

In This Article


This is a retrospective cohort study of 79 consecutive patients treated at a single institution for CO poisoning. This study included 79 cases who were admitted to the Hospital's emergency department due to CO poisoning after attempted suicide during the period between 2002 and 2011. All subjects were divided into two groups, consisting of 13 cases who developed DNS and 66 cases who did not, and were reviewed for clinical symptoms and laboratory findings at admission to the emergency department, circumstances of injury, treatment received during the acute phase, and other information to the extent available in the emergency department setting.

Patient medical records were retrospectively reviewed, and patients who developed DNS and patients who did not develop DNS were compared in terms of 16 items: gender, age, location of exposure, estimated duration of exposure, whether or not the patient was transported from another hospital, severity of impaired consciousness (i.e., Japan Coma Scale [JCS] score) when the patient was first seen at a hospital,[19] CO-Hb level when the patient was first seen at a hospital, white blood cell (WBC) count and CK, CK-MB, and LDH levels on the day the patient was seen, whether or not there were abnormal findings from a head CT scan when the patient was first seen, whether or not HBO therapy was administered on the day the patient was seen, diagnostic category according to "Mental and behavioural disorders" in the International Classification of Diseases, Tenth Revision (ICD-10),[20] duration of hospital stay, and number of sessions of HBO therapy.

In addition, the patients were assessed in terms of their psychiatric symptoms using a Japanese version (by Kitamura, et al.)[21] of the Oxford University version of the Brief Psychiatric Rating Scale (BPRS), and were also investigated in terms of their general psychiatric symptoms and abilities of daily living using a Japanese translation by Kitamura, et al. of the Global Assessment Scale (GAS).[22] Furthermore, the patients' life events prior to their attempted suicide were assessed using the Life Change Units (LCU) of the Holmes Social Readjustment Rating Scale.[23]

Note that JCS scores and CO-Hb levels used in this study were those obtained at the first medical institution, not necessarily the Hospital, to which each patient was admitted in emergency, since quite a few cases were transferred to the Hospital under oxygen administration after consultation at another medical institution.

Assessment and diagnosis of each review item were performed by an emergency psychiatrist or the Hospital's psychiatrist on duty.

Statistical processing was performed using SPSS 17.0J for Windows. Testing of mean values, ratios and JCS scores was conducted using one-way analysis of variance, a chi-square test and the Mann-Whitney U test, respectively. In all tests, the level of significance was 5%, with significance probabilities being expressed in numbers.

This study is a chart review study and we did not obtain informed consent. Personally identifiable information was excluded from data. Consideration was given to the protection of personal information in the process of data management and processing. This study was conducted with the approval of the Ethics Committee of the Iwate Medical University, School of Medicine.