Clinical features of children with carbon monoxide intoxication: a single center study

Purpose To investigate the effect of lifestyle changes on patterns of carbon monoxide (CO) exposure and the association between neurologic symptoms and outcomes in Korean children with CO intoxication. Methods We reviewed the medical records of patients (< 18 years) with CO intoxication who visited the emergency department of Pusan National University Hospital between February 2012 and January 2020. We collected clinical findings, including age and sex, transfer from other hospitals, source, time and duration of exposure, manifestations with neurologic symptoms (syncope, seizure, and altered mental status), intensive care unit hospitalization, hospital length of stay, implementation of hyperbaric oxygen therapy, and findings of neuroimaging. These variables were compared between children with and without neurologic symptoms. In addition, levels of carboxyhemoglobin and lactate were compared between patients with and without specific manifestations. Results The enrolled 47 patients’ median age was 10 years (interquartile range, 4.5-14.0). The most common source of exposure was fire (46.8%), followed by camping (23.4%). The most common times of exposure were night (44.7%) and winter (44.7%). The patients with neurologic symptoms (14 [29.8%]) showed longer duration of exposure and hospital length of stay (P < 0.001 and P = 0.007, respectively). Of the 14 patients, 2 were hospitalized to the intensive care unit without an in-hospital mortality. A significant association was found between dyspnea and lactate level (P = 0.049), also between syncope or presyncope and carboxy hemoglobin level (P = 0.017). Conclusion CO intoxication in Korean children is most often caused by fire and camping, and at night and in winter. There is a correlation between neurologic symptoms and duration of exposure to CO.