Predictors of Severe Clinical Course in Children With Carbon Monoxide Poisoning

Abstract

Objective Carbon monoxide (CO) is a gas, which is produced by incomplete combustion of hydrocarbon-containing substances, and causes significant tissue and organ damage in the common event of CO poisoning. This study aims to evaluate the demographic, clinical, and laboratory characteristics of patients diagnosed with CO poisoning in the emergency department and to determine the factors associated with severe course in the acute phase of poisoning. Methods A total of 331 patients diagnosed with CO poisoning in Hacettepe University Children's Hospital, Pediatric Emergency Unit, between January 2004 and March 2014 were included in the study. Their demographic characteristics, presenting complaints, physical examination findings, Glasgow Coma Scale scores, carboxyhemoglobin, leukocyte, hemoglobin, troponin T, pH and lactate levels, type of treatment (normobaric or hyperbaric oxygen), intensive care unit admissions, and outcome of poisoning were investigated. Results Ninety-three patients were given hyperbaric oxygen. Fifty-one patients were admitted to the pediatric intensive care unit, 18 patients have had a severe clinical course, and 6 patients have died. The risk factors associated with severe disease course were determined to be low Glasgow Coma Scale score, high leukocyte count, and high troponin T levels at presentation. Conclusions Glasgow Coma Scale score, leukocyte count, and troponin T level may be beneficial in predicting clinical outcomes and tailoring therapy in children with CO poisoning.

The effect of full blood count and cardiac biomarkers on prognosis in carbon monoxide poisoning in children

“…Han et al reported that NLR was predictive for myocardial injury in patients with CO poisoning [ 37 ]. In a study by Akcan Yildiz in pediatric patients with CO poisoning, it was reported that a high leukocyte count was useful in predicting prognosis and directing treatment [ 38 ]. In a study by Moon et al with adults with CO poisoning, it was shown that both admission neutrophil count and NLR were predictive of troponin-I elevation when used together with clinical parameters in patients without troponin-I elevation or ischemic ECG changes at admission [ 26 ].…”

The Diagnosis and Treatment of Carbon Monoxide Poisoning

“…These negative results are contrasted by a recently published, large retrospective cohort analysis, which showed reduced fatality after HBOT especially in patients younger than 20 years (34) (Table 3). In parallel to adults, children (0-18 years, median 11 years) with severe CO poisoning also had raised troponin T concentrations (39).…”

Beyond Complete Blood Cell Count Parameters

“…These factors include advanced age, prolonged CO exposure, high carboxyhemoglobin levels, altered mental status upon presentation, prolonged coma, delayed time to treatment, metabolic acidosis, elevated lactate levels, myocardial injury with high troponin T levels, and early brain computed tomography findings (such as globus pallidus or white matter lesions). In additionally, Glasgow Coma Scale score, Poison Severity Score, CO-modified Poison Severity Score, and Sequential Organ Failure Assessment score have been identified as important predictors of COP prognosis 2–6 …”

“…In additionally, Glasgow Coma Scale score, Poison Severity Score, CO-modified Poison Severity Score, and Sequential Organ Failure Assessment score have been identified as important predictors of COP prognosis. [2][3][4][5][6] To obtain a comprehensive evaluation of a patient's overall status and prognosis in cases of COP, it is crucial to consider multiple inflammatory biomarkers and clinical variables, as well as incorporate a comprehensive risk stratification score. Although the study by Guven et al adds to our understanding of the potential role of MPV and RDW in predicting COP severity, relying solely on these markers may not provide sufficient information to accurately predict patient outcomes and guide treatment decisions, particularly in cases where hyperbaric oxygen therapy is needed.…”