Comparing Noninvasive Pulse CO-Oximeter vs Blood Gas Analysis in Emergency Department Patients with Carbon Monoxide Poisoning

Yıl 2018, Cilt: 1 Sayı: 1, 1 - 4, 21.09.2018

Sinan Kaya Mehtap Bulut , Behçet Varışlı Yalçın Katı Ulaş Karaoğlu

Öz

Introduction: In order to diagnose carbon monoxide (CO) poisoning, clinical suspicion, a reliable history, and the detection of high level of carboxyhemoglobin (COHb) in blood gas analysis are required. The purpose of this study is to compare noninvasive pulse CO-oximetry versus blood gas analysis (BGA) in emergency department (ED) patients with CO poisoning.

Methods: From the patients, who were 18 years of age or over, presenting with suspicion of CO poisoning and who were eligible for inclusion in the study, arterial/venous blood gas samples were collected and SpCO was measured by pulse CO-oximetry and recorded by the time of ED visit. Sensitivity and specificity percentages, positive and negative predictive values were determined with ROC analysis. Bland-Altman analysis was used to assess the agreement between two measurement methods.

Results: The study was carried out prospectively on 213 patients in total, 133 (62%) of whom were female with a mean age of 38 ± 15. The limits of agreement were -6.5 to 9.9% COHb (bias 1.7%, precision 4.1%). Cut off value in CO measurement was 23, sensitivity was 97.2%, specificity was 80.4%, NPV was 96.6%, and PPV was 83%. Concordance coefficient value (0.868) between BGA, and pulse CO-oximetry was found out to be significantly high.

Conclusion: When pulse CO-oximetry is compared with BGA, it appears to diagnose CO poisoning rapidly and accurately and therefore, it may be used both in pre-hospital period and EDs as a screening test for CO poisoning.

Anahtar Kelimeler

Carbon monoxide (CO) poisoning, noninvasive pulse CO-oximetry, blood gas analysis, emergency department

Karbonmonoksit Zehirlenmesi ile Acil Servise Başvuran Hastalarda Noninvaziv Nabız CO-oksimetre ile Kan Gazı Analizinin Karşılaştırılması

Öz

Giriş: Karbon monoksit (CO) zehirlenmesinin tanısı için klinik şüphe, güvenilir bir anamnez ve kan gazında yüksek karboksihemoglobin (COHb) düzeyinin saptanması gereklidir. Bu çalışmada CO zehirlenmesi ile acil servise başvuran hastalarda noninvaziv nabız CO-oksimetre ile kan gazı analizinin karşılaştırılması amaçlanmıştır.

Metot: CO zehirlenmesi şüphesi olan ve çalışmaya dahil edilmeye uygun 18 yaş ve üzeri hastalarda, acil servis başvurusu esnasında arteriyel/venöz kan gazı örnekleri alınmış ve nabız CO- oksimetre ile SpCO düzeyleri ölçülmüştür. ROC analizi yapılarak sensitivite, spesifite, negatif prediktif değer (NPD) ve pozitif prediktif değer (PPD) saptanmıştır. İki ölçüm metodu arasındaki uyumu değerlendirmek için Bland-Altman analizi kullanılmıştır.

Bulgular: Çalışma toplam 213 hasta üzerinde prospektif olarak yapılmıştır. Hastaların 133’ü (%62) kadın olup ortalama yaş 38 ± 15’tir. Uyum sınırları -6.5 ila 9,9% COHb’dir (bias %1,7, kesinlik %4,1). CO ölçümü için sınır değeri 23, sensitivite %97,2, spesifite %80,4, NPD %96,6, PPD %83 olarak hesaplanmıştır. Kan gazı analizi ile nabız CO-oksimetre arasındaki uyum katsayısı değeri (0,868) anlamlı ölçüde yüksek bulunmuştur.

Sonuç: Nabız CO-oksimetre, kan gazı ile karşılaştırıldığında CO zehirlenmesinde hızlı ve hassas bir biçimde tanı koymaktadır ve hem hastane öncesi dönemde hem de acil servislerde CO zehirlenmesi için bir tarama testi olarak kullanılabilir.

Anahtar Kelimeler

Karbon monoksit (CO) zehirlenmesi, noninvaziv nabız CO-oksimetre, kan gazı analizi, acil servis

Kaynakça

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