Turnbull T L, Hart R G, Strange G R, Cooper M A, Lindblad R, Watkins J M, Ferraro C M
University of Illinois Affiliated Hospitals Emergency Medicine Residency, Mercy Hospital and Medical Center, Chicago, Illinois 60616.
Ann Emerg Med. 1988 May;17(5):478-83. doi: 10.1016/s0196-0644(88)80240-3.
Carbon monoxide (CO) is the leading toxic cause of death in the United States today. Unsuspected exposure to this gas will sometimes result in clinically significant, but undiagnosed, toxicity. A high incidence of such unsuspected exposures would make screening for these worthwhile among high-risk populations. We conducted a two-part study to determine the value of screening for unsuspected CO exposure in a population of patients presenting to an emergency department. The first part of our study involved the prospective screening of ED patients using CO breath analysis, regardless of their chief complaint. In the second part, COHGB levels of all patients who underwent arterial blood gas analysis during the study period were reviewed retrospectively. Of 1,038 patients screened by this combined approach, only 29 (2.8%) had abnormal CO breath readings and/or COHGB levels. Of a condensed subgroup of 152 patients defined retrospectively by chief complaint, eight (5.3%) had abnormal values. We conclude that routine screening of ED patients for unsuspected CO exposure is not practical. Although yield increases when patients are screened in a more selective manner on the basis of chief complaint, such an increase still does not appear to justify the screening process.
一氧化碳（CO）是当今美国中毒致死的首要原因。未被察觉的这种气体暴露有时会导致临床上显著但未被诊断出的毒性反应。如此高比例的未被察觉的暴露情况会使得在高危人群中进行筛查变得很有价值。我们开展了一项分为两部分的研究，以确定在就诊于急诊科的患者群体中筛查未被察觉的CO暴露的价值。我们研究的第一部分涉及对急诊科患者进行前瞻性筛查，使用CO呼气分析，无论其主要诉求是什么。在第二部分中，对研究期间所有接受动脉血气分析的患者的碳氧血红蛋白（COHGB）水平进行回顾性审查。通过这种联合方法筛查的1038例患者中，只有29例（2.8%）的CO呼气读数和/或COHGB水平异常。在根据主要诉求回顾性定义的152例患者的精简亚组中，有8例（5.3%）的值异常。我们得出结论，对急诊科患者进行未被察觉的CO暴露的常规筛查是不切实际的。尽管基于主要诉求以更具选择性的方式对患者进行筛查时阳性率会增加，但这种增加似乎仍不足以证明筛查过程的合理性。
