Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study
BackgroundCarbon monoxide (CO) poisoning is an important cause of morbidity and mortality worldwide. Symptoms are mostly aspecific, making it hard to identify, and its diagnosis is usually made through blood gas analysis. However, the bulkiness of gas analyzers prevents them...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-10-01
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| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2023/1/e48057 |
| _version_ | 1797664046559789056 |
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| author | Matthieu Lyon Christophe Alain Fehlmann Marc Augsburger Thomas Schaller Catherine Zimmermann-Ivol Julien Celi Birgit Andrea Gartner Nicolas Lorenzon François Sarasin Laurent Suppan |
| author_facet | Matthieu Lyon Christophe Alain Fehlmann Marc Augsburger Thomas Schaller Catherine Zimmermann-Ivol Julien Celi Birgit Andrea Gartner Nicolas Lorenzon François Sarasin Laurent Suppan |
| author_sort | Matthieu Lyon |
| collection | DOAJ |
| description |
BackgroundCarbon monoxide (CO) poisoning is an important cause of morbidity and mortality worldwide. Symptoms are mostly aspecific, making it hard to identify, and its diagnosis is usually made through blood gas analysis. However, the bulkiness of gas analyzers prevents them from being used at the scene of the incident, thereby leading to the unnecessary transport and admission of many patients. While multiple-wavelength pulse oximeters have been developed to discriminate carboxyhemoglobin (COHb) from oxyhemoglobin, their reliability is debatable, particularly in the hostile prehospital environment.
ObjectiveThe main objective of this pilot study was to assess whether the Avoximeter 4000, a transportable blood gas analyzer, could be considered for prehospital triage.
MethodsThis was a monocentric, prospective, pilot evaluation study. Blood samples were analyzed sequentially with 2 devices: the Avoximeter 4000 (experimental), which performs direct measurements on blood samples of about 50 µL by analyzing light absorption at 5 different wavelengths; and the ABL827 FLEX (control), which measures COHb levels through an optical system composed of a 128-wavelength spectrophotometer. The blood samples belonged to 2 different cohorts: the first (clinical cohort) was obtained in an emergency department and consisted of 68 samples drawn from patients admitted for reasons other than CO poisoning. These samples were used to determine whether the Avoximeter 4000 could properly exclude the diagnosis. The second (forensic) cohort was derived from the regional forensic center, which provided 12 samples from documented CO poisoning.
ResultsThe mean COHb level in the clinical cohort was 1.7% (SD 1.8%; median 1.2%, IQR 0.7%-1.9%) with the ABL827 FLEX versus 3.5% (SD 2.3%; median 3.1%, IQR 2.2%-4.1%) with the Avoximeter 4000. Therefore, the Avoximeter 4000 overestimated COHb levels by a mean difference of 1.8% (95% CI 1.5%-2.1%). The consistency of COHb readings by the Avoximeter 4000 was excellent, with an intraclass correlation coefficient of 0.97 (95% CI 0.93-0.99) when the same blood sample was analyzed repeatedly. Using prespecified cutoffs (5% in nonsmokers and 10% in smokers), 3 patients (4%) had high COHb levels according to the Avoximeter 4000, while their values were within the normal range according to the ABL827 FLEX. Therefore, the specificity of the Avoximeter 4000 in this cohort was 95.6% (95% CI 87%-98.6%), and the overtriage rate would have been 4.4% (95% CI 1.4%-13%). Regarding the forensic samples, 10 of 12 (83%) samples were positive with both devices, while the 2 remaining samples were negative with both devices.
ConclusionsThe limited difference in COHb level measurements between the Avoximeter 4000 and the control device, which erred on the side of safety, and the relatively low overtriage rate warrant further exploration of this device as a prehospital triage tool. |
| first_indexed | 2024-03-11T19:23:37Z |
| format | Article |
| id | doaj.art-02aca060eafd467c99e965017fbcae85 |
| institution | Directory Open Access Journal |
| issn | 2561-326X |
| language | English |
| last_indexed | 2024-03-11T19:23:37Z |
| publishDate | 2023-10-01 |
| publisher | JMIR Publications |
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| series | JMIR Formative Research |
| spelling | doaj.art-02aca060eafd467c99e965017fbcae852023-10-06T13:44:29ZengJMIR PublicationsJMIR Formative Research2561-326X2023-10-017e4805710.2196/48057Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation StudyMatthieu Lyonhttps://orcid.org/0000-0002-6507-0865Christophe Alain Fehlmannhttps://orcid.org/0000-0002-4163-0338Marc Augsburgerhttps://orcid.org/0000-0002-5606-3831Thomas Schallerhttps://orcid.org/0000-0002-5502-0055Catherine Zimmermann-Ivolhttps://orcid.org/0000-0001-8631-6812Julien Celihttps://orcid.org/0000-0002-8534-8908Birgit Andrea Gartnerhttps://orcid.org/0000-0003-0726-3201Nicolas Lorenzonhttps://orcid.org/0009-0007-6356-9818François Sarasinhttps://orcid.org/0000-0002-1169-8526Laurent Suppanhttps://orcid.org/0000-0001-6989-6421 BackgroundCarbon monoxide (CO) poisoning is an important cause of morbidity and mortality worldwide. Symptoms are mostly aspecific, making it hard to identify, and its diagnosis is usually made through blood gas analysis. However, the bulkiness of gas analyzers prevents them from being used at the scene of the incident, thereby leading to the unnecessary transport and admission of many patients. While multiple-wavelength pulse oximeters have been developed to discriminate carboxyhemoglobin (COHb) from oxyhemoglobin, their reliability is debatable, particularly in the hostile prehospital environment. ObjectiveThe main objective of this pilot study was to assess whether the Avoximeter 4000, a transportable blood gas analyzer, could be considered for prehospital triage. MethodsThis was a monocentric, prospective, pilot evaluation study. Blood samples were analyzed sequentially with 2 devices: the Avoximeter 4000 (experimental), which performs direct measurements on blood samples of about 50 µL by analyzing light absorption at 5 different wavelengths; and the ABL827 FLEX (control), which measures COHb levels through an optical system composed of a 128-wavelength spectrophotometer. The blood samples belonged to 2 different cohorts: the first (clinical cohort) was obtained in an emergency department and consisted of 68 samples drawn from patients admitted for reasons other than CO poisoning. These samples were used to determine whether the Avoximeter 4000 could properly exclude the diagnosis. The second (forensic) cohort was derived from the regional forensic center, which provided 12 samples from documented CO poisoning. ResultsThe mean COHb level in the clinical cohort was 1.7% (SD 1.8%; median 1.2%, IQR 0.7%-1.9%) with the ABL827 FLEX versus 3.5% (SD 2.3%; median 3.1%, IQR 2.2%-4.1%) with the Avoximeter 4000. Therefore, the Avoximeter 4000 overestimated COHb levels by a mean difference of 1.8% (95% CI 1.5%-2.1%). The consistency of COHb readings by the Avoximeter 4000 was excellent, with an intraclass correlation coefficient of 0.97 (95% CI 0.93-0.99) when the same blood sample was analyzed repeatedly. Using prespecified cutoffs (5% in nonsmokers and 10% in smokers), 3 patients (4%) had high COHb levels according to the Avoximeter 4000, while their values were within the normal range according to the ABL827 FLEX. Therefore, the specificity of the Avoximeter 4000 in this cohort was 95.6% (95% CI 87%-98.6%), and the overtriage rate would have been 4.4% (95% CI 1.4%-13%). Regarding the forensic samples, 10 of 12 (83%) samples were positive with both devices, while the 2 remaining samples were negative with both devices. ConclusionsThe limited difference in COHb level measurements between the Avoximeter 4000 and the control device, which erred on the side of safety, and the relatively low overtriage rate warrant further exploration of this device as a prehospital triage tool.https://formative.jmir.org/2023/1/e48057 |
| spellingShingle | Matthieu Lyon Christophe Alain Fehlmann Marc Augsburger Thomas Schaller Catherine Zimmermann-Ivol Julien Celi Birgit Andrea Gartner Nicolas Lorenzon François Sarasin Laurent Suppan Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study JMIR Formative Research |
| title | Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study |
| title_full | Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study |
| title_fullStr | Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study |
| title_full_unstemmed | Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study |
| title_short | Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study |
| title_sort | evaluation of a portable blood gas analyzer for prehospital triage in carbon monoxide poisoning instrument validation study |
| url | https://formative.jmir.org/2023/1/e48057 |
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