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. 2023 Dec 28:10:1250845.
doi: 10.3389/fmed.2023.1250845. eCollection 2023.

The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis

Giacomo Ramponi  1 , Francesca Gianni  1   2 , Eleni Karlafti  3 , Isabelle Piazza  1   4 , Francesco Albertoni  5 , Giorgio Colombo  2 , Giovanni Casazza  1   2 , Anna Garegnani  2 , Rosa Casella  2 , Giorgio Costantino  1   2
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The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis

Giacomo Ramponi et al. Front Med (Lausanne). .

Abstract

Introduction: Acute 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.

Methods: We 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).

Results: A 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).

Conclusion: Our 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.

Keywords: carbon monoxide; carbon monoxide poisoning; carboxyhemoglobin; diagnostic accuracy; intoxication; oximetry; pulse oximetry; systematic review & meta-analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Evaluation of risk of bias and applicability concerns according to QUADAS-2 tool.
Figure 3
Figure 3
Forest plot of sensitivity and specificity of SpCO at a cut-off of 10%.
Figure 4
Figure 4
Plot of the studies in the ROC space. Circles represent individual studies. The solid black circle represents the pooled estimate of sensitivity and specificity. The dotted border represents 95% confidence region.
See this image and copyright information in PMC

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