Carbon monoxide-related fatalities: A 60-year single institution experience

ObjectiveThough carbon monoxide (CO) poisonings account currently for a relatively small percentage of total non-natural deaths in Europe, they represent a serious public health burden and significant component of avoidable mortality in many countries. Our aim was to investigate long-term trends and to determine epidemiologic characteristics of the CO-related deaths in the Czech Republic, recorded at the Department of Forensic Medicine in Hradec Králové.MethodsThis was an autopsy-based single-centre retrospective cohort study of all fatalities caused by CO poisoning over six decades (1947–2006). All data were numerically evaluated and processed using NCSS 10 Statistical Software. Statistical significance was defined as a p-value less than 0.05.ResultsA total of 1233 CO-related deaths were identified for inclusion in the study. The manner of death was ranked in order as follows: 45% accidental poisoning, 40% suicidal poisoning, 1% homicidal poisoning, 14% remained undetermined. There were slightly more male victims (59%) than female, and the mean age overall was 48 years. The majority of CO-related fatalities were attributed to coal gas inhalation, with the remainder being from inhaled motor vehicle exhaust fumes, inhaled fire smoke, and other combustion sources such as charcoal, gas and wood-burning appliances. The mean blood carboxyhemoglobin (COHb) level was 66%. A positive blood ethanol concentration was measured in 455 (37%) cases examined. Non-intentional poisonings were highly correlated with the winter months.ConclusionThis study shows that the prevalence of CO-related deaths has decreased significantly in the Czech Republic following the widespread detoxification of the domestic gas in the 1990–1995. Our findings suggest that acute ethanol use, poorer socioeconomic position, and inadequate education status about the danger of CO are associated with an increased risk of fatal CO poisoning. Finally, our results demonstrate the continued value of the autopsy in monitoring global public health security issues and socioeconomic situation. Further similar large-scale studies in different populations are needed to improve the targeting of interventions to the groups with the highest level of risk, and to understand the sources of variation in CO-related mortality.     

Unintentional carbon monoxide poisoning in Northwest Iran: A 5-year study

This paper describes the epidemiology of unintentional carbon monoxide (CO) poisoning in Northwest Iran between 2003 and 2008. Data were obtained from the records of the main provider of emergency medical transportation and from death certificate reports of the Legal Medicine Organization. During the study period, a total of 3078 hospital admissions were recorded against which 346 deaths were due to unintentional CO related poisoning caused by gas appliances in the homes. The ratio of unintentional CO related poisoning cases in relation to all poisonings was 11.6%. With regard to gender differences, non-fatal CO poisoning was higher in females than males, whereas actual fatalities were higher in males than females. Non-fatal CO poisoning was most prevalent in adults aged between 20 and 49 years, whereas the age specific death rate was highest for those over 60 years. The highest frequency of both non-fatal poisonings and actual fatalities occurred in the month January. The results suggest that CO poisoning has a high prevalence in this geographic region, with elderly adults being at the greatest risk, especially during the winter season. This represents a serious, but often neglected area of public health, and Health Authorities should be encouraged to promote public awareness against the dangers of CO exposure. This paper reviews the data and evidence surrounding the issue of CO poisoning and makes recommendations that a range of agencies and authorities should be involved in setting stricter standards and environmental legislations in this respect.     

T?dliche verlaufende Kohlenstoffmonoxidintoxikationen

During the past two years the number of cases offatal carbon monoxide poisoning apparently increased in the Magdeburg area and surroundings due to the use of charcoal barbecue grills in closed rooms. In an experimental approach CO concentrations released by combustion of various materials (e.g. charcoal, wood briquettes and bamboo cook chips) during a barbecue process were measured in a closed container. The resulting gas concentrations as well as the temperatures in the room and embers were recorded. The results revealed that the CO concentrations inside the container reached values which can cause death after approximately 30?C60?min depending on the accompanying conditions (e.g. type of charcoal, amount and condition of the remaining embers). In particular, the occurrence of a situation critical to health must be expected when using an indoor grill for more than 60?min. The results were reported to the German Federal Ministry of Food, Agriculture and Consumer Protection to minimise the long-term specific risk for a cause of death by ??CO poisoning as a result of operating a barbecue in a closed room??, e.g. by affixing an explicit warning on the charcoal packaging.     

Carbon monoxide poisoning: a new incidence for an old disease.

PURPOSE: While carbon monoxide (CO) poisoning is common in the USA, its incidence is uncertain. Fatal poisonings are counted with relative accuracy from death certificate data, but estimates of the more common nonfatal poisonings are either old or limited. This study was performed to estimate the number of emergency department (ED) visits annually in the USA for carbon monoxide poisoning. BASIC PROCEDURES: ED visit rates in five states (Idaho, Maine, Montana, Utah, and Washington) from three prior studies, each using different methodology, were used to extrapolate independent estimates of national ED visits. MAIN FINDINGS: After correcting for regional differences in CO poisoning incidence, estimates of national ED visits per year ranging from 32,413 to 56,037 were obtained. Excluding the estimate derived from the Maine rate because it did not include intentional and fire-related poisonings, the national average is 50,558 +/- 4,843 visits per year. CONCLUSIONS: There are approximately 50,000 ED visits for CO poisoning in the USA annually, 3-5 times the numbers previously estimated. As this disease can result in significant long-term morbidity even when treated, enhanced prevention efforts are warranted.     

高压氧对CO中毒大鼠海马中钙离子cGMP及血浆NO含量的影响

目的　测定一氧化碳（ＣＯ）中毒大鼠海马中钙离子（［Ｃａ２＋ ］ｉ）浓度与环磷酸鸟苷（ｃＧＭＰ）含量以及血浆一氧化氮（ＮＯ）含量的变化,同时观察高压氧（ＨＢＯ）在其间的作用。方法　８６ 只实验大鼠被随机分成１１ 组,分别为正常（对照）组;ＣＯ 中毒后１、３、５、１０、２０ 天５个组（ＣＯ组）;ＣＯ中毒后＋ ＨＢＯ１、３、５、１０、２０天５ 个组（ＣＯ＋ ＨＢＯ组）。分别用流式细胞仪测定大鼠海马中钙离子浓度和用酶免法测定海马神经元内ｃＧＭＰ含量,再用分光光度法测定大鼠血浆ＮＯ含量。结果　ＣＯ组海马中［Ｃａ２＋ ］ｉ浓度在ＣＯ中毒后第３、５、１０ 天和ｃＧＭＰ含量在第１、３、５、１０ 天明显低于对照组（Ｐ＜ ０．０１）,均于第２０ 天接近对照组（Ｐ＞ ０．０５）;血浆ＮＯ浓度在中毒后第１、３、５、１０ 天明显低于对照组（Ｐ＜ ０．０１）,至第２０ 天仍未恢复正常（Ｐ＜ ０．０５）。而ＣＯ＋ ＨＢＯ组海马中［Ｃａ２＋ ］ｉ浓度和ｃＧＭＰ含量以及血浆ＮＯ浓度在ＣＯ中毒后虽有变化但与ＣＯ组比,各时期数值均较接近对照组。并在第１０ 天后恢复正常。结论　ＣＯ中毒后,大鼠海马神经元细胞内钙离子、ｃＧＭＰ与血浆ＮＯ含量均降低,并持续较长时间。ＣＯ中     

Trends in fatal poisonings in Leeds, 1977 to 1987

The records of all deaths due to poisoning investigated by the Leeds University Department of Forensic Medicine, over an eleven-year period between 1977 and 1987, were studied. There were 422 cases consisting of 208 males and 214 females. Two of these cases were homicidal in nature (both were unconnected cases of children poisoned with amitriptyline). Only 12 were accidental and the rest either suicidal or para-suicidal. More than 20% of cases had recorded blood ethanol levels greater than the legal driving limit of 80 mg of alcohol per 100 ml of blood. The results show a steady decrease in the number of deaths from poisoning over this period, due mainly to falls in self-poisonings from barbiturates and non-steroidal anti-inflammatory drugs. Curiously, the number of carbon monoxide poisonings was the same in 1987 as 1977. Some interesting trends and sex variations have also been highlighted.     

高压氧对急性CO中毒患者血清心脏肌钙蛋白T含量的影响(论著)

目的：观察高压氧（HBO）对急性一氧化碳（CO）中毒患者血清心脏肌钙蛋白T（troponinT，TnT）含量变化的影响，并探讨HBO对心肌损伤的疗效及机理。方法：对17例急性CO中毒患者，分别于HBO治疗前和1次治疗后评定Glasgow分数，同时测定血清TnT。对其中6例急性中、重度CO中毒患者在5次HBO治疗后复测血清TnT含量。结果：HBO治疗前后比较，急性轻度CO中毒患者血清TnT含量无显著差异（P＞0．05），急性中、重度CO中毒患者血清TnT含量显著下降（P＜0．05）；而6例急性中、重度CO中毒患者血清TnT含量，在HBO治疗1次、5次后均较治疗前非常明显下降（P＜0．01）。结论：急性中、重度CO中毒均有心肌损伤；HBO治疗可降低血清TnT，表明是治疗急性CO中毒心肌损伤的有效方法。     

高压氧对急性一氧化碳中毒大鼠血清蛋白脂质蛋白质抗原、抗体的影响

目的 观察急性一氧化碳中毒(acute carbon monoxide poioning,ACOP)大鼠血清中蛋白脂质蛋白质(proteolipid protein,PLP)抗原、抗体的变化,探讨免疫机制在ACOP中的作用以及高压氧(HBO)治疗可能的作用机制.方法 202只大鼠按随机数字表法分为3组:染毒组(CO组),高压氧组(HBO组),常压氧组(NBO组).采用静态一氧化碳吸入法建立ACOP大鼠模型.染毒前及染毒后即刻、100 min和3、7、10、20 d取腹主动脉血,用ELISA法测定血清PLP抗原、抗体的含量.结果 染毒后即刻CO组、HBO组和NBO组PLP抗原及抗体均较染毒前升高(P＜0.05).HBO组100 min时PLP抗原低于CO组(P＜0.05);3、7 d时PLP抗体低于CO组(P＜0.05);3、10 d时HBO组PLP抗体低于NBO组(P＜0.05);7、20 d时NBO组PLP抗体低于CO组(P＜0.05).结论 ACOP后大鼠存在自身免疫反应及髓鞘损伤,及时、规律的HBO治疗可减轻髓鞘损伤.     

高压氧和抗血小板聚集剂预防一氧化碳中毒迟发脑病

目的 观察高压氧（HBO）和抗血小板聚集剂综合疗法对一氧化碳中毒（COP）迟发脑病的预防效应。方法 中，重度急性一氧化碳中毒患者共401例，随机分成HBO治疗组（HBO）组204例和HBO＋抗血小板聚集剂治疗组（HBO＋抗Pla组）197例。HBO治疗压力0.2MPa，每日1次，共20次，在患者COP后第15，20，25，30，45，60天判定是否出现迟发脑病。结果 COP患者401例中，HBO组204例，出现迟发脑病23例，占11．27％。HB＋抗Pla组197例，出现迟发脑病7例，占3．55％。两组比较差异有非常显著性（P＜0．01）。结论 HBO和抗血小板聚集剂综合治疗急性COP，使其迟发脑病的发生率较单纯HBO治疗明显降低，取得显著的预防效应。     

高压氧对急性一氧化碳中毒大鼠下丘脑-垂体-肾上腺轴的作用研究

目的:探讨高压氧(HBO)治疗对急性一氧化碳(CO)中毒大鼠下丘脑-垂体-肾上腺(HPA)轴的作用。方法:将36只大鼠按照随机数字表法分为正常对照组、CO中毒组和HBO治疗组各12只。建立急性CO中毒大鼠模型,给予HBO治疗7 d后,采用转录组测序(RNA-seq)进行各组大鼠脑组织基因检测,采用实时定量PCR(RT-...     

Pesticide poisoning cases in Ankara and nearby cities in Turkey: An 11-year retrospective analysis

Since they are available in open markets and pharmacies, pesticides have been widely used all over the country. (Un)intentional poisoning with these compounds is one of the most common causes of chemical poisoning, especially in rural agricultural areas. Pesticide poisonings reported by various countries showed that it is a worldwide health problem with 250 000–370 000 associated deaths each year.In this study, medico-legal deaths between the years 2001 and 2011 in Ankara and nearby cities in Turkey were investigated retrospectively. The autopsies were partly carried out by Ankara Branch of Council of Forensic Medicine. Data were collected from reports of the Morgue Department whose toxicological analyses were performed in the Chemistry Department. The data revealed that 70 cases out of 10 720 autopsied ones had been attributed to fatal pesticide poisoning. The age range was 1–80 years (mean ± SD, 41.33 ± 17.42 years). Most of the cases (60%) were reported from Ankara. Insecticides were the most common (94%) cause of fatal pesticide poisonings, most of them (63%) being organophosphate insecticides. The percentages of pesticide-induced deaths are quite high in our society and should therefore not be underestimated. Accordingly, intensive efforts to reduce occupational and intentional pesticide poisonings are urgently needed in Ankara and nearby cities.     

Questionnaire results of hyperbaric oxygen therapy for acute carbon monoxide poisoning in Japan

Carbon monoxide (CO) poisoning results in not only severe psychoneurological disorders, but can also cause secondary delayed psychoneurological disorders. Therefore, timely and appropriate treatment in the acute stage is crucial to prevent such direct neurological damage and secondary disorders. However, various conflicting results have been reported in studies of CO poisoning treatment, and the efficacy of hyperbaric oxygen therapy (HBO2T) for CO poisoning has not been established. This retrospective multi-institutional study was performed by the questionnaire in 1667 cases of acute CO poisoning in Japan. The effectiveness of HBO2T for CO poisoning was evaluated based on prognoses in cases and various classes of hospital based on the grade of their positive stance regarding HBO2T. The results showed that the prognosis in the group treated with HBOT was significantly better than that in the group treated with normobaric oxygen therapy (NBO2T) (P < 0.01), thus confirming the effectiveness of HBO2T for CO poisoning. Furthermore, while hospitals were separated into three groups according to their indication criteria for HBO2T, the ineffective ratio of NBO2T was dependent on the indication criteria, even though the effective ratio of HBO2T was the same in all three groups. In conclusion, a retrospective multi-institutional study showed that HBO2T is an effective form of therapy for CO poisoning.     

A death in a stationary vehicle whilst idling: unusual carbon monoxide poisoning by exhaust gases

In this paper, we describe an autopsy case in which death was due to accidental carbon monoxide poisoning occurring in a stationary vehicle idling in an open space. To investigate the source of the fatal fumes, the death scene situation was reconstructed using the vehicle. Exhaust gases were found to invade the interior through the floor from a defective exhaust system. CO gas was detected while idling and the level in the cabin gradually rose to 1.5% over a 2-h period. Since the 8-year-old motor vehicle seemed to have been defective for some months, it was concluded that stationary idling overnight caused an accumulation of toxic gases in the interior.     

A profile of acute poisoning at Mangalore (South India)

BACKGROUND: The aim of this study was to characterize the poisoning cases admitted to the Government Wenlock Hospital (a teaching hospital of Kasturba Medical College) Mangalore, India. STUDY DESIGN: All cases admitted to the emergency department of the hospital between January 2001 to May 2003 evaluated retrospectively. Data obtained from the hospital medical records and included the following factors: socio-demographic characteristics, agents and route of intake, and time of admission of the acutely poisoned patients. RESULTS: Of the total 33,207 patients admitted in the hospital for treatment, 325 patients were for to acute poisoning. This was 1% of all emergency admissions. Of these 70% were males and 30% females. The majority (36%) cases were from age group of 21-30 years. Most (72%) poisonings were intentional and only 27% were unintentional. The most important agents of acute poisoning were agrochemical pesticides (49%) followed by drugs (17%), and alcohols (13%). Forty-eight (15%) patients died. The poisons responsible for most of the mortality were organophosphate pesticides (65%) and aluminium phosphide (15%). In summary, the prevention and treatment of poisoning due to organophosphate and aluminium phosphide should merit high priority in the health care of the indigenous population of South India (Dakshina Kannada district).     

Hyperbaric oxygen treatment for carbon monoxide poisoning in pregnancy: a case report.

Carbon monoxide (CO) poisoning is one of the most common forms of poisoning in the United States. When CO poisoning occurs in the pregnant patient, it is extremely toxic to the mother and fetus in terms of central nervous system disorders and delayed central nervous system sequelae. Controversy exists in treating the pregnant patient with hyperbaric oxygen (HBO) because of the unknown effects of high partial pressures of oxygen on the fetus. HBO therapy is beneficial in CO poisoning because of its effect of first increasing oxygen concentration and causing a shift in the oxygen dissociation curve from the left to the right. Second, by causing a diminished CO interaction with cytochrome oxidase, HBO allows mitochondria to use oxygen more effectively. Third, HBO may reduce lipid peroxidation which may be responsible for neurological deterioration and delayed central nervous system sequelae. Fourth, decreased CO influence through HBO may reduce changes in the myocardium as a result of CO poisoning, if cardiovascular disease is already present. A case study of successful HBO therapy used during pregnancy is presented and effects of CO on the fetus are discussed.     

Forensic and clinical carbon monoxide (CO) poisonings in Turkey: A detailed analysis

Carbon monoxide (CO) is produced by incomplete combustion of organic compounds. Its intoxication usually results from inhalation of fumes from improper heating stoves, motor vehicles, or smoke from fires. It can reversibly bind various heme-containing proteins such as hemoglobin, myoglobin, cytochrome p450 and cytochrome oxidases. Among them, it has a high affinity for hemoglobin (230–270 times more avidly than oxygen) with which it forms carboxy-hemoglobin (HbCO) leading to decrease in oxygen-carrying capacity followed by end-organ hypoxia. A tissue hypoxia may then result in transient or permanent damage of important organs like central nervous system and even death. CO poisonings from different reasons are an important cause of morbidity and mortality in Turkey. The purpose of this study on CO poisonings in Turkey is to sum up and analyze the best available researches in both forensic and clinical toxicology fields. This was achieved by synthesizing the results of Turkish and English papers on forensic and clinical CO poisoning cases conducted in universities, institutes, hospitals and other official or private organizations in Turkey. Total of 47,523 medico-legal autopsy data collected from 9 different forensic medicine branches and emergency rooms in different year intervals were reviewed and 980 CO poisoning cases were determined. To calculate the frequency of CO poisoning within all the autopsies carried out and fatal poisoning cases, the number of cases was divided by the total number of medico-legal autopsies and total fatal poisoning cases. The mean age of cases, the source of CO gas, the most common seasons and months, gender, and blood HbCO levels were also taken into consideration if the data is available. Under the light of the findings, we may suggest that determination of affecting factors in CO poisoning is going to be one of the key subjects for planning preventive interventions.     

不同高压氧治疗方案对急性一氧化碳中毒受损心肌的疗效分析

目的 探讨不同高压氧(hyperbaric oxygen,HBO)治疗方案对急性一氧化碳(carbon monoxide,CO)中毒受损心肌的影响.方法 对2006年10月至2010年3月收治的155例重症CO中毒患者进行HBO常规治疗(常规组,75例)和HBO改进治疗(改进组,80例).(1)常规组治疗方案:治疗压力0.25 MPa,加压20 min,稳压后吸氧2次,每次30 min,中间间歇10 min,减压20 min出舱.每日1次,12次为1个疗程,治疗9-68次.(2)改进组方案:前5 d采用HBO常规治疗,以后采用减小治疗压力、缩短吸氧时间、增加吸氧间隔、间歇给氧的治疗方案,治疗压力0.20 MPa,稳压吸氧4次,每次10min,中间间歇5 min,减压20 min出舱.连续治疗3 d后间隔1 d,10 d为1个疗程.2组患者使用相同的药物治疗方案.统计分析常规组和改进组ST-T变化及血清心肌酶变化.结果 改进组与常规组相比ST-T恢复率(56%,28%)明显升高(P＜0.05),HBO治疗第3天和第6天ST-T加重率(第3天21%、25%.第6天16%、27%)明显降低(P＜0.01);2组血清心肌酶恢复率和加重率比较差异有统计学意义(P＜0.05.P＜0.01).结论 HBO改进方案对CO中毒患者受损心肌疗效较好.

Abstract：

Objective To investigate the effects of different hyperbaric oxygen ( HBO) treatment profiles on damaged myocardium induced by acute carbon monoxide poisoning. Methods One hundred and fifty-five serious cases of acute carbon monoxide ( CO) poisoning admitted into the hospital for treatment from October 2006 to March 2010 were randomly divided into the routine HBO treatment group (the routine group,75 cases) and the improved HBO treatment group (the improved group,80 cases). The treatment profile of the routine HBO treatment group: the patients were compressed for 20 min to the treatment pressure of 0.25 Mpa. Following stabilization at the said pressure, the patients breathed oxygen twice for 30 min plus 10 min, once a day. The whole treatment course consisted of 12 sessions, with the patients receiving HBO treatments from 9 to 68 times. The treatment profile of the improved HBO treatment group: the patients were given routine HBO treatment in the first 5 days, then, received improved HBO treatment, with a treatment profile of lower pressure (0.20 Mpa) , shorter oxygen-breathing time, lengthening of oxygen-breathing intervals and intermittent oxygen breathing. Total oxygen-breathing time was 4 times, each for 10 min plus 3 times each for 5 min. Then, the patients were decompressed to the surface following 20-min oxygen-breathing decompression. The patients received treatment for a succession of 3 days, then, had 1-day interval, and the whole treatment course consisted of 10 sessions. Changes in ST-T and myocardial enzymes of both the routine HBO treatment group and the improved HBO treatment group were measured and analyzed. Results ST-T recovery rate of the improved HBO treatment group increased (56% ,28% ) obviously, when compared with that of the routine HBO treatment group(P ＜ 0. 05). ST-T worse rate decreased significantly following HBO treatment on the 3rd and 6th days (21% and 25% on the 3rd day, 16% and 27% on the 6th day) respectively (P＜0.01). Statistical differences could be seen in the myocardial recovery rate and worse rate, when a comparison was made between them (P＜0. 05, P＜0. 01). Conclusions The improved HBO treatment profile showed better therapeutic effect on damaged myocardium induced by CO poisoning. This treatment profile should be used instead of other treatment profiles.     

Hyperbaric treatment of patients with carbon monoxide poisoning in the United States.

INTRODUCTION: Hyperbaric oxygen (HBO2) is effective therapy for carbon monoxide (CO) poisoning. In recent years, many hyperbaric physicians in the US have felt that numbers of patients referred for treatment of CO poisoning have decreased. Further, since the 2002 Weaver et al study (5), there has been discussion regarding the best treatment protocol. This study was conducted to determine numbers of patients treated with HBO2 annually over the past decade in the US and whether there is a consensus about the number of treatments per patient. MATERIALS AND METHODS: A survey was mailed to all US facilities listed in the 2001 UHMS Chamber Directory. Two subsequent mailings were sent to survey nonresponders, followed by telephone contacts. RESULTS: Of the 320 facilities listed in the directory, 10 were nonresponders, 26 had closed since publication and 80 do not treat CO poisoning, leaving 204 facilities. From 1992-2002, a total of 16,367 patients were treated with HBO2 for CO poisoning, an average of 1,488 +/- 121 patients/year (mean < or = SD). While the total number of patients treated annually did not decrease during the period studied, the number treated per facility did decline as a result of an increase in number of treating facilities. Only 46 facilities (23%) automatically give more than 1 hyperbaric treatment per CO-poisoned patient. Among those that do, 20 facilities (10%) give 3 treatments per patient. Conversely, 136 (67%) sometimes give more than one treatment and 12 facilities (8%) never retreat. CONCLUSIONS: Approximately 1,500 CO-poisoned patients are treated with HBO2 in the US annually, a number that has remained relatively constant since 1992. The majority of facilities does not routinely give more than one hyperbaric treatment, but will give repetitive treatment in certain situations.     

Basal ganglia volumes following CO poisoning: A prospective longitudinal study.

Carbon monoxide (CO) poisoning may result in focal and diffuse neuropathological changes, including basal ganglia lesions. The effect of CO poisoning on basal ganglia volumes over time is unclear. We assessed basal ganglia volumes longitudinally following CO poisoning. We prospectively enrolled 73 CO poisoned patients who underwent brain MR imaging on day 1 (baseline), 2 weeks, and 6 months post-CO poisoning. Basal ganglia volumes were obtained. One patient had bilateral globus pallidus lesions at two weeks and 6 months. Of the CO-poisoned patients 28% had volume reduction in at least one basal ganglia structure by 6 months, of which 21% had putamen, 15% had caudate, 15% had globus pallidus, and 16% had total basal ganglia volume reduction. Putamen volumes were significantly smaller from baseline to six months (p = 0.02). Verbal memory and mental processing speed correlated with smaller putamen and globus pallidus volumes. Carbon monoxide poisoning results in basal ganglia volume reduction 6 months post CO poisoning. Slow mental processing speed and impaired memory correlated with smaller putamen and globus pallidus volumes. Clinicians need to be aware of basal ganglia neuropathologic changes in the absence of observable lesions following CO poisoning.     

Partnering with a medical specialty society to perform online public health surveillance

While accidental carbon monoxide (CO) poisoning is common, it is felt to be largely preventable through targeted public education. Development of effective education programs requires accurate epidemiologic information about the condition. Many acute, severe cases of CO poisoning are treated with hyperbaric oxygen (HBO2) at hospital-based facilities staffed by members of the Undersea and Hyperbaric Medical Society (UHMS). In 2008, the Centers for Disease Control and Prevention (CDC) began sponsoring a UHMS proposal to use online reporting by UHMS members of cases treated with HBO2. This report describes development and implementation of the internet-based surveillance system, as well as its first year of operation. From August 2008 to July 2009, a total of 740 cases were reported by the 82 hyperbaric facilities participating nationwide. Extensive epidemiologic information about CO poisoning in the United States has been collected, and the utility of partnering with a medical specialty society for disease-specific surveillance demonstrated.