Emerg Med J doi:10.1136/emermed-2012-202152
  • Original article

Features and predictors of myocardial injury in carbon monoxide poisoned patients

  1. Hyun Kim
  1. Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju city, Kangwon Province, Republic of Korea
  1. Correspondence to Dr Hyun Kim, Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, 162 Ilsandong, Wonju city, Kangwon Province 220-701, Republic of Korea; khyunsahara{at}
  • Received 14 November 2012
  • Revised 24 December 2012
  • Accepted 6 January 2013
  • Published Online First 24 January 2013


Background and purpose By contrast with neurologic injury, myocardial injury associated with carbon monoxide (CO) poisoning has not been well investigated. Therefore, this study assessed features and predictors of myocardial injury in CO poisoned patients.

Subjects and methods 250 CO poisoning cases that were diagnosed and treated by the emergency department of Wonju Christian Hospital from January 2006 to February 2012 were retrospectively reviewed.

Results Fifty (20%) out of 250 patients with CO poisoning developed myocardial injury. Among those with elevated troponin I (Tn I), peak levels occurred at 11.0 (IQR, 4.5–18.5) h normalising by 65.0 (IQR 44.0–96.0) h. CO exposure time, and total and ICU admission length was longer (7.5 (IQR 3.7–10.0) h vs 3.0 (IQR 1.0–7.5) h, p<0.001; 3.5 (IQR 0.0–7.0) days and 0.0 (IQR 0.0–1.25) days vs 0.0 (IQR 0.0–2.0) days and 0.0 (IQR 0.0–0.0) days, p<0.001, respectively) in the myocardial vs non-myocardial injury group. The predictors of myocardial injury were male gender, Glasgow Coma Scale (GCS) ≤14, and CO exposure time ≥2 h (OR (95% CI) of 3.341 (1.171 to 9.531), 9.920 (3.763 to 26.150), and 7.743 (1.610 to 37.238), respectively).

Conclusions Myocardial injury developed in 20% of CO poisoned patients. Time to normalisation and of peak Tn I level in elevated Tn I group was 65.0 (IQR 44.0–96.0) h and 11.0 (IQR 4.5–18.5) h. Presence of myocardial injury was associated with poorer prognosis. Predictors of myocardial injury included male gender, GCS of 14 or less, or CO exposure times greater than 2 h.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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