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Screening for carbon monoxide in children
R Shenoi1, G Stewart, N Rosenberg
1Department of Emergency Medicine, Children's Hospital of Michigan, Detroit 48201, USA.
Insights
A CO breath analyzer effectively detects pediatric carbon monoxide (CO) exposure. This screening tool identified elevated CO levels in 1.9% of children, revealing sources like faulty furnaces and smoking.
Area of Science:
- Environmental Health
- Pediatric Toxicology
- Diagnostic Tools
Background:
- Carbon monoxide (CO) poisoning is a leading cause of fatal poisonings in the US.
- Limited screening studies exist for pediatric CO exposure.
- Identifying CO exposure sources in children is crucial for prevention.
Purpose of the Study:
- To evaluate the utility of a CO breath analyzer for detecting pediatric CO exposure.
- To identify common sources of CO exposure in children presenting to an emergency department.
Main Methods:
- Prospective screening study in a pediatric emergency department.
- 470 non-critically ill children (5-20 years) used a CO breath analyzer.
- Elevated breath CO levels (> or = 9 ppm) confirmed with cooximetry; CO sources identified via history and home evaluation.
Main Results:
- 1.9% (9/470) of children had elevated CO levels (breath and blood carboxyhemoglobin - COHb).
- Identified sources included faulty furnaces and active/environmental tobacco smoke.
- Good correlation found between breath CO analysis and blood COHb (concordance correlation = 0.739).
Conclusions:
- CO breath analysis is a convenient tool for estimating pediatric CO exposure.
- This method can effectively identify older children at risk of CO poisoning.
- Early detection aids in identifying environmental CO hazards.
Objective:
Carbon monoxide (CO), a colorless, odorless gas, accounts for the majority of fatal poisonings in the United States. To date, few screening studies that evaluate pediatric exposure are available. The objectives of this study were to determine the value of a CO breath analyzer for detecting pediatric CO exposure and to identify potential CO sources.
Design:
Prospective screening study.
Setting:
Emergency department of an urban children's hospital.
Patients:
A convenience random sample of 470 noncritically ill children, aged five to 20 years, who presented to a pediatric emergency department and could blow into a CO breath analyzer.
Intervention:
After informed consent and demographic and clinical variables were ascertained, eligible patients blew into a CO breath analyzer. Those with breath CO levels > or = 9 ppm underwent confirmatory cooximetric analysis of capillary blood. Sources of CO exposure were determined by history and a home-site evaluation by the local gas company. Patients with carboxyhemoglobin (COHb) levels of more than 5% were given normobaric 100% oxygen until their COHb levels were less than 5%.
Results:
1.9% (9/470) of patients had elevated breath CO levels and COHb levels by cooximetry. Putative sources of CO exposure were active cigarette smoking for five patients and a faulty furnace in the home for one patient. On the basis of the history, we believe environmental tobacco smoke or automobile exhaust or both contributed to the elevated COHb levels in the other three patients. There was a good correlation between COHb by cooximetry and breath analysis (concordance correlation = 0.739) CONCLUSION: Breath analysis for CO is a convenient tool to estimate exposure and identify older children at risk.