Wang et al evaluated several markers for poor prognosis in a patient with acute carbon monoxide poisoning. These can help to identify a patient who may require more aggressive management. The authors are from Pusan National University and Samsung Changwon Hospital in South Korea.
Patient selection: acute carbon monoxide poisoning, >= 15 years of age
Primary outcome: cerebral performance category at discharge, with poor outcome 3 to 5
Parameters:
(1) Poison Severity Score (original PSS used, not the modified score for CO poisoning)
(2) SOFA score on admission to ED
(3) SOFA score at 24 hours after ED arrival
|
Parameter
|
Finding
|
Points
|
|
PSS on admission
|
<= 2
|
0
|
|
|
> 2
|
1
|
|
initial SOFA
|
<= 2
|
0
|
|
|
> 2
|
1
|
|
SOFA after 24 hours
|
<= 1
|
0
|
|
|
> 1
|
1
|
number of predictors for poor outcome =
= SUM(points for all 3 parameters)
Interpretation:
• minimum number: 0
• maximum number: 3
• The presence of 1 or more findings indicates risk of poor outcome.
Blood lactate and 24-hour change in SOFA score also are associated with poor outcome but show worse performance.
Performance:
• The area under the ROC curves was 0.98 for PSS and 24 hour SOFA and 0.95 for admission SOFA.
