Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning

Kim, Sung Hwa; Lee, Yoon-Suk; Kang, Soo Young; Paik, Jin Hui; Kim, Hyun; Sung, Yong

doi:10.1001/jamanetworkopen.2022.10552

Cited by 5 publications

(1 citation statement)

References 51 publications

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“…It only analyzed factors that may be related to severe poisoning. A study of CO poisoning in patients aged 16 or older 17 showed that the main endpoint outcome was neurocognitive sequelae in the subsequent 4 A retrospective study from Taiwan on children showed that acute seizures, severe metabolic acidosis, signi cantly low blood pressure, prolonged unconsciousness, and longer hospitalization time were associated with delayed neurological sequelae (DNS) 5 . A total of 30 children were included in the study, and only 5 (16.7%) children developed delayed neurological sequelae, but all recovered completely within 2 months.…”

Section: The Severity Of Carbon Monoxide Poisoningmentioning

confidence: 99%

Analysis of long-term prognosis of neurological sequelae in children with carbon monoxide poisoning

Wen,

Liang,

Wei

et al. 2024

Preprint

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Background Carbon monoxide poisoning is a common gas poisoning in emergency rooms during winter, but there are very few reports on carbon monoxide poisoning in children and long-term follow-ups. Epidemiological studies have shown that in China, infants (0-4 years old) and elderly people (70 years old and above) have a higher risk of DALYs (disability-adjusted life years), while young people (15-24 years old) have a higher risk of CO poisoning1. For carbon monoxide poisoning in children, long-term cognitive impairment, if it occurs, will have a detrimental effect on children's neurodevelopment and long-term healthy growth. Method: This study retrospectively analyzed children admitted to the Fourth Affiliated Hospital of Guangxi Medical University for carbon monoxide poisoning from January 2018 to December 2022, and followed up on their neurological sequelae for a long period of time. The study was approved by the Ethics Committees of the Fourth Affiliated Hospital of Guangxi Medical University (the identification code was KY2023131) and informed consent was obtained from all participants and/or their legal guardians. The study complied with the Declaration of Helsinki. Through GDS scores, we further compared the differences between children with and without cognitive impairment，and identified some risk factors for long-term cognitive impairment in children after carbon monoxide poisoning. Result A total of 113 children were included in the study, with an average follow-up of 3.6 years (3.6±1.5 years). Among them, 13 children (11.5%, 13/113) had cognitive abnormalities. The use of gas water heaters in enclosed bathrooms (101 cases, 89.4%) was the most common cause of poisoning in children in this study, followed by heating with fire (11 cases, 9.7%). In addition, one child was forgotten by his father in a running car, resulting in poisoning. The clinical manifestations of children with cognitive abnormalities were mainly consciousness disorders (67 cases, 59.3%), dizziness or headache (37 cases, 32.7%), and other manifestations including irritability, crying, vomiting, limb weakness, and limb twitching, a total of 9 cases. The duration of consciousness disorders in children with cognitive abnormalities was mostly more than 1 day, with a median of 5 days, and the hospitalization time was longer. Children with cognitive abnormalities had higher CRP levels, higher D-dimer levels, and higher liver enzyme levels. The most common imaging change after carbon monoxide poisoning in children was cerebral edema, with two cases of subarachnoid hemorrhage observed and one case of demyelinating changes observed. For children with coma time less than 1 hour, there were few abnormal changes in cranial imaging. Children with cognitive abnormalities were more likely to develop epilepsy (38.5%, 5/13) and other system damage (53.8%, 7/13) during hospitalization, including pulmonary infection (3 cases), stressful gastrointestinal bleeding (2 cases), electrolyte imbalance (2 cases), liver and kidney or myocardial dysfunction (3 cases), and some children had multiple system damage at the same time. There were statistical differences in the admission carbon monoxide hemoglobin level, fibrinogen, D-dimer, high-sensitivity C-reactive protein, neuron enolase, ALT/AST, lactate dehydrogenase, length of hospital stay, discharge and admission GCS scores, seizure frequency, duration of consciousness disorders exceeding 1 day, cranial imaging changes, use of ventilators, presence of other system damage, number of HBOT treatments, and whether the patient was transferred to another hospital between the two groups of children. Multivariate logistic regression analysis showed that the need to transfer to a higher-level hospital for treatment due to the severity of the condition and longer duration of coma were independent risk factors for cognitive impairment after long-term follow-up. Conclusion For children with an unconsciousness of more than 1 hour, it is recommended to consider performing a head imaging examination as soon as possible within 3 days after CO exposure to guide the treatment of the acute phase. For children who are transferred from lower-level hospitals to higher-level hospitals for treatment after poisoning, with an unconsciousness of more than 1 day or 5 days and more, long-term follow-up should be conducted to determine whether delayed encephalopathy or long-term cognitive impairment occurs, and timely and long-term intervention measures should be formulated.

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Section: The Severity Of Carbon Monoxide Poisoningmentioning

confidence: 99%

Analysis of long-term prognosis of neurological sequelae in children with carbon monoxide poisoning

Wen,

Liang,

Wei

et al. 2024

Preprint

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Methodological concerns about score of delayed neuropsychiatric sequelae after carbon monoxide poisoning

Shi

Zhang²

2023

The American Journal of Emergency Medicine

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Analysis of prognosis of neurological sequelae in children with carbon monoxide poisoning

Wen,

Liang,

Wei

et al. 2024

Sci Rep

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This study retrospectively analyzed children admitted to the Fourth Affiliated Hospital of Guangxi Medical University for CO (carbon monoxide) poisoning from January 2018 to December 2022 and followed up on their neurological sequelae for a long time. The study was approved by the Ethics Committees of the Fourth Affiliated Hospital of Guangxi Medical University (the identification code was KY2023131) and informed consent was obtained from all participants and/or their legal guardians. The study complied with the Declaration of Helsinki. Through Global Deterioration Scale [GDS], we further compared the differences between children with and without cognitive impairment, and identified some risk factors for long-term cognitive impairment in children after CO poisoning. The GDS score of the patient was based on the follow-up score, and we only conducted one follow-up and recorded the GDS score throughout the entire study period. The follow-up time interval is defined as the time from the first discharge of the patient to our follow-up. A total of 113 children were encompassed in the study, with an average follow-up of 3.6 years (3.6 ± 1.5 years). Among them, 13 children (11.5%, 13/113) had cognitive abnormalities. The utilization of gas water heaters in enclosed bathrooms (101 cases, 89.4%) constituted the most frequent cause of CO poisoning among children in this study, followed by heating with fire (11 cases, 9.7%). Furthermore, one child was left by his father in a running car, thereby resulting in poisoning. The clinical manifestations of CO poisoning in children were mainly consciousness disorders (67 cases, 59.3%), dizziness or headache (37 cases, 32.7%), and other manifestations including irritability, crying, vomiting, limb weakness, and limb twitching, a total of 9 cases. The duration of consciousness disorders in children with cognitive abnormalities was mostly more than one day, with a median of 5 days, and the hospitalization time was longer. Children with cognitive abnormalities had higher C-reactive protein (CRP) levels, higher D-dimer levels, and higher liver enzyme levels. The most common imaging change after CO poisoning in children was cerebral edema, with two cases of subarachnoid hemorrhage observed and one case of demyelinating changes observed. For children with coma time less than one hour, there were few abnormal changes in cranial imaging. Children with cognitive abnormalities were more likely to develop epilepsy (38.5%, 5/13) and other system damage (53.8%, 7/13) during hospitalization, including pulmonary infection (3 cases), stressful gastrointestinal bleeding (2 cases), electrolyte imbalance (2 cases), dysfunction of liver, kidney or myocardial (3 cases), and some children had multiple system damage at the same time. There were statistical differences in the admission CO hemoglobin level, fibrinogen, D-dimer, high-sensitivity CRP, neuron enolase, alanine aminotransferase or aspartate aminotransferase (ALT or AST), lactate dehydrogenase, length of hospital stay, discharge and admissi...

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Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning

Cited by 5 publications

References 51 publications

Analysis of long-term prognosis of neurological sequelae in children with carbon monoxide poisoning

Analysis of long-term prognosis of neurological sequelae in children with carbon monoxide poisoning

Methodological concerns about score of delayed neuropsychiatric sequelae after carbon monoxide poisoning

Analysis of prognosis of neurological sequelae in children with carbon monoxide poisoning

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