Predictors for delayed encephalopathy following acute carbon monoxide poisoning.
BACKGROUND
In Japan, many carbon monoxide (CO) poisoning cases are transported to emergency settings, making treatment and prognostic assessment an urgent task. However, there is currently no reliable means to predict whether "delayed neuropsychiatric sequelae (DNS)" will develop after acute CO poisoning. This study is intended to find out risk factors for the development of DNS and to characterize the clinical course following the development of DNS in acute CO poisoning cases.


METHODS
This is a retrospective cohort study of 79 consecutive patients treated at a single institution for CO poisoning. This study included 79 cases of acute CO poisoning admitted to our emergency department after attempted suicide, who were divided into two groups consisting of 13 cases who developed DNS and 66 cases who did not. The two groups were compared and analyzed in terms of clinical symptoms, laboratory findings, etc.


RESULTS
Predictors for the development of DNS following acute CO poisoning included: serious consciousness disturbance at emergency admission; head CT findings indicating hypoxic encephalopathy; hematology findings including high creatine kinase, creatine kinase-MB and lactate dehydrogenase levels; and low Global Assessment Scale scores. The clinical course of the DNS-developing cases was characterized by prolonged hospital stay and a larger number of hyperbaric oxygen (HBO) therapy sessions.


CONCLUSIONS
In patients with the characteristics identified in this study, administration of HBO therapy should be proactively considered after informing their family, at initial stage, of the risk of developing DNS, and at least 5 weeks' follow-up to watch for the development of DNS is considered necessary.
Department of Neuropsychiatry, Iwate Medical University, school of Medicine, Morioka, Iwate, Japan. kudok@iwate-med.ac.jp.
Kaoru
K
Kudo
Kotaro
K
Otsuka
Junko
J
Yagi
Katsumi
K
Sanjo
Noritaka
N
Koizumi
Atsuhiko
A
Koeda
Miki Yokota
MY
Umetsu
Yasuhito
Y
Yoshioka
Ayumi
A
Mizugai
Toshinari
T
Mita
Yu
Y
Shiga
Fumito
F
Koizumi
Hikaru
H
Nakamura
Akio
A
Sakai
D000328:Adult; D002249:Carbon Monoxide Poisoning / Q000097:blood / Q000150:complications* / Q000628:therapy; D052279:Creatine Kinase, MB Form / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D002534:Hypoxia, Brain / Q000139:chemically induced* / Q000000981:diagnostic imaging; D045022:Lactate Dehydrogenases / Q000097:blood; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000139:chemically induced*; D011569:Psychiatric Status Rating Scales; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013406:Suicide, Attempted; D013997:Time Factors; D055815:Young Adult
D045022:Lactate Dehydrogenases; D052279:Creatine Kinase, MB Form