Original ContributionsEmergency department visits for carbon monoxide poisoning in the Pacific Northwest
Introduction
Accidental carbon monoxide (CO) poisoning is extremely common in the United States. The significance of this form of poisoning as a cause of death is repeatedly emphasized in the medical literature 1, 2. Approximately 1,000 deaths occurred annually from accidental CO poisoning in the United States from 1979 to 1988 (1).
Data on nonfatal CO poisoning are more difficult to obtain. The National Electronic Injury Surveillance System (NEISS) of the United States Consumer Product Safety Commission (CPSC) tracks emergency department (ED) visits for injuries associated with consumer products or recreational activities in a probability sample of 91 hospitals. This tracking system includes injuries from CO poisoning. The NEISS estimates that 5,900 individuals were treated in hospital EDs in 1995 for non-fire-related CO poisoning associated with the use of household appliances (3). This estimate, however, does not include cases due to occupational exposure or those associated with motor vehicles. The significance of such sources of CO poisoning cannot be underestimated, as they may be responsible for a significant proportion of CO-related injuries. In the case of motor vehicles, for example, it has been reported that automobiles are responsible for a majority of accidental CO poisoning deaths in the United States (1).
It is commonly reported in the medical literature that there are 10,000 cases of CO poisoning annually in the United States sufficiently severe to cause afflicted individuals to seek medical attention or to lose one or more days of normal activity. This estimate, however, was originally published in the medical literature in 1974 and may be outdated (4). The present study was designed to investigate the current number of annual ED visits for CO poisoning in the Pacific Northwest, and to attempt to derive a national estimate of ED visits from the results.
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Materials and methods
All 178 hospital emergency departments in the states of Washington, Idaho, and Montana were surveyed by mail in early 1995 with regard to their patient experience for the preceding calendar year. They were questioned about the total number of patients evaluated in their department in 1994 and asked to estimate the number of patients seen with acute carbon monoxide poisoning. A repeat mailing and subsequent telephone contacts (up to three) were performed as necessary to achieve a 100% response
Results
Data were received from all 178 hospital emergency departments in the region studied (91 in Washington, 38 in Idaho, and 49 in Montana). In calendar year 1994, a total of 2,505,528 ED visits were reported in the three states, of which an estimated 1,325 were for CO poisoning (Table 1 ). The rate of ED evaluation for CO poisoning was 13.6 per 100,000 population in Washington, 22.4 per 100,000 in Idaho, and 40.4 per 100,000 in Montana.
Extrapolation of these figures to the entire United States was
Discussion
Since the estimate of 10,000 cases annually of nonfatal CO poisoning in the United States was originally published in the medical literature in 1974 (4), it has been referenced repeatedly by investigators in the field of CO poisoning as representative of the significance of the problem in the United States 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. In addition to the fact that the estimate is likely outdated, the figure may underestimate the total CO poisoning problem for some of the same reasons
Acknowledgements
The author wishes to thank Ms. Kathy Dalrymple for her effort and perseverance in obtaining survey data, thereby achieving a 100% response rate.
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2012, Journal of the Formosan Medical AssociationCitation Excerpt :Also, among those who seek medical care, there is the potential that the diagnosis of CO poisoning may be missed. Furthermore, the symptoms of CO poisoning are nonspecific and only the serious and fatal CO poisoning cases were reported.5,6 This was the situation described in our report.