Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan.
Am J Emerg Med. 2022 Aug;58:73-78. doi: 10.1016/j.ajem.2022.05.012. Epub 2022 May 13.
Carbon monoxide poisoning (COP), resulting from accidental and intentional exposure, is a leading cause of fatal poisoning worldwide. Except for early death, neurological sequelae are common and impose a large burden on patients, caregivers, and the society.
This retrospective study included patients who visited the emergency departments (EDs) of the medical institutes of Chang Gung Memorial Hospital after COP with a carboxyhemoglobin level > 10% between January 2009 and October 2018. Patients who experienced out-of-hospital cardiac arrest (OHCA) were excluded. Poor outcome was defined as mortality or a Glasgow coma scale (GCS) <13 at discharge. Stepwise regression analysis was performed, and a receiver operating characteristic (ROC) curve was applied to analyze our newly created scoring system for prognosis prediction.
This study enrolled 1171 patients. Fire scene (F) (aOR, 20.635; 95% CI, 8.345-51.023), intentional CO exposure (I) (aOR, 2.634; 95% CI, 1.335-5.196), respiratory failure (R) (aOR, 9.944; 95% CI, 5.533-17.873), every point of reduced GCS (E) (aOR, 1.253; 95% CI, 1.186-1.323), and diabetes mellitus (D) (aOR, 2.749; 95% CI, 1.201-6.292) were identified as predictors of poor outcomes. The FIRED score was created.
The FIRED score could predict the outcomes of non-OHCA patients with a carboxyhemoglobin level > 10% after COP using five factors that can be obtained by history taking and basic examination. An FIRED score ≥ 10 was associated with a poor outcome (sensitivity, 89.6%; specificity, 82.4%; AUC0.930).
一氧化碳中毒（COP）是一种由意外和故意暴露引起的疾病，是全球范围内导致致命中毒的主要原因。除了早期死亡，神经后遗症很常见，给患者、护理人员和社会带来了沉重的负担。
这项回顾性研究纳入了 2009 年 1 月至 2018 年 10 月期间，在长庚纪念医院急诊部就诊的 COP 患者，其碳氧血红蛋白水平>10%，且排除发生院外心脏骤停（OHCA）的患者。预后不良定义为死亡或出院时格拉斯哥昏迷量表（GCS）<13。进行了逐步回归分析，并应用受试者工作特征（ROC）曲线分析我们新创建的预后预测评分系统。
这项研究共纳入了 1171 例患者。火灾现场（F）（优势比，20.635；95%置信区间，8.345-51.023）、故意 CO 暴露（I）（优势比，2.634；95%置信区间，1.335-5.196）、呼吸衰竭（R）（优势比，9.944；95%置信区间，5.533-17.873）、每降低 1 分的 GCS（E）（优势比，1.253；95%置信区间，1.186-1.323）和糖尿病（D）（优势比，2.749；95%置信区间，1.201-6.292）是预后不良的预测因子。创建了 FIRED 评分。
FIRED 评分可以使用病史和基本检查获得的五个因素预测 CO 中毒后碳氧血红蛋白水平>10%的非 OHCA 患者的结局。FIRED 评分≥10 与预后不良相关（灵敏度，89.6%；特异性，82.4%；AUC0.930）。
