Ramponi Giacomo, Gianni Francesca, Karlafti Eleni, Piazza Isabelle, Albertoni Francesco, Colombo Giorgio, Casazza Giovanni, Garegnani Anna, Casella Rosa, Costantino Giorgio
Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy.
Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Front Med (Lausanne). 2023 Dec 28;10:1250845. doi: 10.3389/fmed.2023.1250845. eCollection 2023.
Acute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and applied to the setting of suspected COP. The aim of this systematic review is to assess the diagnostic accuracy of CO pulse oximetry (SpCO) with carboxyhemoglobin (COHb) levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP.
We developed our search strategy according to the PICOS framework, population, index/intervention, comparison, outcome, and study, considering the diagnostic accuracy of SpCO compared to COHb levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP enrolled in cross-sectional studies in English. The search was performed on MEDLINE/PubMed and EMBASE in February 2022. Quality assessment was performed using the QUADAS-2 methodology. A COHb cutoff of 10% was chosen to test the sensitivity and specificity of the index test. A bivariate model was used to perform the meta-analysis. The protocol was registered on PROSPERO (CRD42022359144).
A total of six studies (1734 patients) were included. The pooled sensitivity of the test was 0.65 (95% CI 0.44-0.81), and the pooled specificity was 0.93 (95% CI 0.83-0.98). The pooled LR+ was 9.4 (95% CI 4.4 to 20.1), and the pooled LR- was 0.38 (95% CI 0.24 to 0.62).
Our results show that SpCO cannot be used as a screening tool for COP in the ED due to its low sensitivity. Because of its high LR+, it would be interesting to evaluate, if SpCO could have a role in the prehospital setting as a tool to quickly identify COP patients and prioritize their transport to specialized hospitals on larger samples with a prospective design.
急性一氧化碳中毒（COP）是急诊科就诊患者中毒的主要原因之一。COP症状并不总是具有特异性，可能从轻微到严重不等。在过去几年中，一氧化碳血红蛋白脉搏血氧仪已被开发并应用于疑似COP的情况。本系统评价的目的是评估以血气分析测量的碳氧血红蛋白（COHb）水平作为参考标准时，一氧化碳脉搏血氧测定法（SpCO）对疑似COP患者的诊断准确性。
我们根据PICOS框架（人群、指标/干预、对照、结局和研究）制定了检索策略，考虑在以英文发表的横断面研究中纳入的疑似COP患者中，将SpCO与作为参考标准的血气分析测量的COHb水平进行比较的诊断准确性。检索于2022年2月在MEDLINE/PubMed和EMBASE上进行。使用QUADAS-2方法进行质量评估。选择10%的COHb临界值来测试指标检测的敏感性和特异性。使用双变量模型进行荟萃分析。该方案已在PROSPERO（CRD42022359144）上注册。
共纳入六项研究（1734例患者）。该检测的合并敏感性为0.65（95%CI 0.44-0.81），合并特异性为0.93（95%CI 0.83-0.98）。合并阳性似然比为9.4（95%CI 4.4至20.1），合并阴性似然比为0.38（95%CI 0.24至0.62）。
我们的结果表明，由于SpCO敏感性较低，不能将其用作急诊科COP的筛查工具。由于其较高的阳性似然比，如果SpCO能够在前院环境中作为一种工具，用于快速识别COP患者并优先将其转运至专科医院，在更大样本的前瞻性设计中进行评估将是很有意义的。
