The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis
IntroductionAcute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and appl...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-12-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1250845/full |
| _version_ | 1797373901956710400 |
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| author | Giacomo Ramponi Francesca Gianni Francesca Gianni Eleni Karlafti Isabelle Piazza Isabelle Piazza Francesco Albertoni Giorgio Colombo Giovanni Casazza Giovanni Casazza Anna Garegnani Rosa Casella Giorgio Costantino Giorgio Costantino |
| author_facet | Giacomo Ramponi Francesca Gianni Francesca Gianni Eleni Karlafti Isabelle Piazza Isabelle Piazza Francesco Albertoni Giorgio Colombo Giovanni Casazza Giovanni Casazza Anna Garegnani Rosa Casella Giorgio Costantino Giorgio Costantino |
| author_sort | Giacomo Ramponi |
| collection | DOAJ |
| description | IntroductionAcute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and applied to the setting of suspected COP. The aim of this systematic review is to assess the diagnostic accuracy of CO pulse oximetry (SpCO) with carboxyhemoglobin (COHb) levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP.MethodsWe developed our search strategy according to the PICOS framework, population, index/intervention, comparison, outcome, and study, considering the diagnostic accuracy of SpCO compared to COHb levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP enrolled in cross-sectional studies in English. The search was performed on MEDLINE/PubMed and EMBASE in February 2022. Quality assessment was performed using the QUADAS-2 methodology. A COHb cutoff of 10% was chosen to test the sensitivity and specificity of the index test. A bivariate model was used to perform the meta-analysis. The protocol was registered on PROSPERO (CRD42022359144).ResultsA total of six studies (1734 patients) were included. The pooled sensitivity of the test was 0.65 (95% CI 0.44–0.81), and the pooled specificity was 0.93 (95% CI 0.83–0.98). The pooled LR+ was 9.4 (95% CI 4.4 to 20.1), and the pooled LR- was 0.38 (95% CI 0.24 to 0.62).ConclusionOur results show that SpCO cannot be used as a screening tool for COP in the ED due to its low sensitivity. Because of its high LR+, it would be interesting to evaluate, if SpCO could have a role in the prehospital setting as a tool to quickly identify COP patients and prioritize their transport to specialized hospitals on larger samples with a prospective design. |
| first_indexed | 2024-03-08T18:57:09Z |
| format | Article |
| id | doaj.art-b1e686be01f542f287b6f3cd405a6371 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-08T18:57:09Z |
| publishDate | 2023-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-b1e686be01f542f287b6f3cd405a63712023-12-28T11:55:02ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-12-011010.3389/fmed.2023.12508451250845The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysisGiacomo Ramponi0Francesca Gianni1Francesca Gianni2Eleni Karlafti3Isabelle Piazza4Isabelle Piazza5Francesco Albertoni6Giorgio Colombo7Giovanni Casazza8Giovanni Casazza9Anna Garegnani10Rosa Casella11Giorgio Costantino12Giorgio Costantino13Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, ItalyDipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, ItalyPronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyEmergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GreeceDipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, ItalyPronto Soccorso, ASST Papa Giovanni XXIII, Bergamo, ItalyRetired, Latina, ItalyPronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, ItalyPronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyPronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyPronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, ItalyPronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyIntroductionAcute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and applied to the setting of suspected COP. The aim of this systematic review is to assess the diagnostic accuracy of CO pulse oximetry (SpCO) with carboxyhemoglobin (COHb) levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP.MethodsWe developed our search strategy according to the PICOS framework, population, index/intervention, comparison, outcome, and study, considering the diagnostic accuracy of SpCO compared to COHb levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP enrolled in cross-sectional studies in English. The search was performed on MEDLINE/PubMed and EMBASE in February 2022. Quality assessment was performed using the QUADAS-2 methodology. A COHb cutoff of 10% was chosen to test the sensitivity and specificity of the index test. A bivariate model was used to perform the meta-analysis. The protocol was registered on PROSPERO (CRD42022359144).ResultsA total of six studies (1734 patients) were included. The pooled sensitivity of the test was 0.65 (95% CI 0.44–0.81), and the pooled specificity was 0.93 (95% CI 0.83–0.98). The pooled LR+ was 9.4 (95% CI 4.4 to 20.1), and the pooled LR- was 0.38 (95% CI 0.24 to 0.62).ConclusionOur results show that SpCO cannot be used as a screening tool for COP in the ED due to its low sensitivity. Because of its high LR+, it would be interesting to evaluate, if SpCO could have a role in the prehospital setting as a tool to quickly identify COP patients and prioritize their transport to specialized hospitals on larger samples with a prospective design.https://www.frontiersin.org/articles/10.3389/fmed.2023.1250845/fullcarbon monoxidecarbon monoxide poisoningpulse oximetrydiagnostic accuracycarboxyhemoglobinoximetry |
| spellingShingle | Giacomo Ramponi Francesca Gianni Francesca Gianni Eleni Karlafti Isabelle Piazza Isabelle Piazza Francesco Albertoni Giorgio Colombo Giovanni Casazza Giovanni Casazza Anna Garegnani Rosa Casella Giorgio Costantino Giorgio Costantino The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis Frontiers in Medicine carbon monoxide carbon monoxide poisoning pulse oximetry diagnostic accuracy carboxyhemoglobin oximetry |
| title | The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis |
| title_full | The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis |
| title_fullStr | The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis |
| title_full_unstemmed | The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis |
| title_short | The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis |
| title_sort | diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning a systematic review and meta analysis |
| topic | carbon monoxide carbon monoxide poisoning pulse oximetry diagnostic accuracy carboxyhemoglobin oximetry |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1250845/full |
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