Public Health Surveillance and Research, Department of Veterans Affairs, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
BMC Public Health. 2019 Feb 14;19(1):190. doi: 10.1186/s12889-019-6505-y.
Exposure to carbon monoxide (CO), the odorless, colorless gas resulting from incomplete combustion of hydrocarbons, is preventable. Despite the significant risk of morbidity and mortality associated with CO poisoning, there currently exists no active national CO surveillance system in the United States (U.S.). Our study aims to use electronic health record data to describe the epidemiology of CO poisoning in the Veterans Health Administration healthcare population.
We identified unique inpatient and outpatient encounters coded with International Classification of Diseases (ICD) codes for CO poisoning and analyzed relevant demographic, laboratory, treatment, and death data from January 2010 through December 2017 for Veterans across all 50 U.S. states and Puerto Rico. Statistical methods used were 95% CI calculations and the two-tailed z test for proportions.
We identified 5491 unique patients with CO poisoning, of which 1755 (32%) were confirmed/probable and 3736 (68%) were suspected. Unintentional poisoning was most common (72.9%) overall. Age less than 65 years, residence in Midwest U.S. Census region versus South or West, and winter seasonal trend were characteristics associated with confirmed/probable CO poisoning. Twenty-six deaths (1.5%) occurred within 30 days of confirmed/probable CO poisoning and were primarily caused by cardiovascular events (42%) or anoxic encephalopathy (15%).
Our findings support the use of ICD-coded data for targeted CO poisoning surveillance, however, improvements are needed in ICD coding to reduce the percentage of cases coded with unknown injury intent and/or CO poisoning source. Prevalence of CO poisoning among Veterans is consistent with other U.S. estimates. Since most cases are unintentional, opportunities exist for provider and patient education to reduce risk.
一氧化碳（CO）是一种无色无味的气体，由碳氢化合物不完全燃烧产生，是可以预防的。尽管与 CO 中毒相关的发病率和死亡率风险很高，但美国目前尚无活跃的全国性 CO 监测系统。我们的研究旨在使用电子健康记录数据来描述退伍军人健康管理局医疗保健人群中 CO 中毒的流行病学。
我们确定了使用国际疾病分类（ICD）编码为 CO 中毒的独特住院和门诊就诊，并分析了 2010 年 1 月至 2017 年 12 月期间全美所有 50 个州和波多黎各退伍军人的相关人口统计学、实验室、治疗和死亡数据。使用的统计方法是 95%CI 计算和双尾 z 检验。
我们确定了 5491 例 CO 中毒的独特患者，其中 1755 例（32%）为确诊/疑似病例，3736 例（68%）为疑似病例。总体而言，非故意中毒最为常见（72.9%）。年龄小于 65 岁、居住在美国中西部人口普查区而不是南部或西部以及冬季季节性趋势是与确诊/疑似 CO 中毒相关的特征。26 例死亡（1.5%）发生在确诊/疑似 CO 中毒后 30 天内，主要由心血管事件（42%）或缺氧性脑病（15%）引起。
我们的研究结果支持使用 ICD 编码数据进行有针对性的 CO 中毒监测，但是，需要改进 ICD 编码以减少编码为未知损伤意图和/或 CO 中毒源的病例比例。退伍军人中 CO 中毒的患病率与其他美国估计值一致。由于大多数病例是非故意的，因此存在为提供者和患者提供教育以降低风险的机会。
