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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Emergency Medicine 1/2014

Predictors for delayed encephalopathy following acute carbon monoxide poisoning

BMC Emergency Medicine > Ausgabe 1/2014
Kaoru Kudo, Kotaro Otsuka, Junko Yagi, Katsumi Sanjo, Noritaka Koizumi, Atsuhiko Koeda, Miki Yokota Umetsu, Yasuhito Yoshioka, Ayumi Mizugai, Toshinari Mita, Yu Shiga, Fumito Koizumi, Hikaru Nakamura, Akio Sakai
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Conception and design: KK, KO and AS. Acquisition of Data: KK, KS, NK, AK, JY, MYU, YY, AM, TM, YS and FK. Analysis and Interpretation of Data: KK, HK and KO. Drafting the manuscript: KK. Final Approval of the Completed Manuscript: AS. All authors read and approved the final manuscript.



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.


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.


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.


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.
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