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SpCO Screening at Triage Continues to Identify Occult CO Toxicity

  • Selim Suner
    Affiliations
    Department of Emergency Medicine, Department of Surgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, Division of Engineering, Brown University, Providence, Rhode Island
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  • Andrew Sucov
    Affiliations
    Department of Emergency Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island, Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island
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  • Jonathan Valente
    Affiliations
    Department of Emergency Medicine, Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, Rhode Island, Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island
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  • Robert Partridge
    Affiliations
    Department of Emergency Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island, Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island
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  • Gregory Jay
    Affiliations
    Department of Emergency Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island, Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, Division of Engineering, Brown University, Providence, Rhode Island
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      We read with concern the letter by Doctors O'Malley and Chudnofsky. The calculation of sensitivity and specificity in our manuscript is accurate. We clearly indicated that this calculation was based upon patients with paired COHb and SpCO measurements and that this constituted a small portion of the study population. The aim of this study was not to assess the accuracy of this device compared to blood COHb measurements, which was the subject of earlier studies. We discuss the implementation of a screening program using this device to capture occult cases of CO toxicity, which we suspected were in the population at large. In this regard, we have accomplished our goal. We do not suggest that this device replace blood COHb measurements, but rather believe that this device is a good screening tool for identifying unsuspected cases. We do not exclusively use this device on patients who we suspect, for any reason, of having CO toxicity. Instead, we use the standard co-oximetry to determine toxicity in this group of patients. Since the publication of our article, we have continued to use SpCO as an adjunct in triage screening and we continue to identify about 1 patient each month with unsuspected CO toxicity.
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      Reference

        • Chee K.J.
        • Nilson D.
        • Partridge R.
        • et al.
        Finding needles in a haystack: a case series of carbon monoxide poisoning detected using new technology in the emergency department.
        Clin Toxicol (Phila). 2008; 46 (To link to this article: DOI: 10.1080/15563650701725110 URL: http://dx.doi.org/10.1080/15563650701725110): 461-469

      Linked Article

      • Non-Invasive Pulse CO-oximetery: What is Measured?
        Journal of Emergency MedicineVol. 37Issue 3
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          I read with interest the article by Suner and colleagues describing use of a non-invasive pulse CO-oximeter for rapid screening for “CO (carbon monoxide) toxicity” in a high-volume, urban emergency department (1). I commend the authors for the size of their clinical trial but contend that the study was actually using the SpCO measured by the device to screen for elevated carboxyhemoglobin (COHb) levels. Although this may be an issue of semantics, it should be clarified that the device does not measure any index of actual toxicity from CO.
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      • Reply: Elevated SpCO is Most Commonly from an Exogenous Source of Carbon Monoxide
        Journal of Emergency MedicineVol. 37Issue 3
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          We thank Dr. Hampson for his comments in his letter to the editor. Although in the overwhelming majority of cases that present to the emergency department, the elevated carboxyhemoglobin (COHb) is a result of exogenous carbon monoxide (tobacco or otherwise), our title did not specify the source of carbon monoxide toxicity. In our cohort, the patients with elevated SpCO, which was confirmed with COHb measurements, all had exposure to CO (carbon monoxide). There were no cases of hemolysis or other endogenous sources of CO in this group.
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      • Sensitivity of Screening Tests and Other Questions
        Journal of Emergency MedicineVol. 37Issue 3
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          We were quite interested to read the results reported by Dr. Suner et al. regarding their use of a non-invasive carboxyhemoglobin detector (RAD-57, Masimo Corp., Irvine, CA), given that our experience with the device was very different from theirs (1).
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