Fire deaths in Cape Town, South Africa: A retrospective review of medico-legal and toxicological findings (2006 - 2018).

BACKGROUND: In South Africa, fire-related deaths are common, particularly within dense informal housing settlements. Published data on deaths from fire incidents in Cape Town is sparse. Additionally, little emphasis has been placed on the role of toxicological investigations in these deaths, despite the known risk of alcohol and drug impairment to burn injury. METHODS: A retrospective, descriptive analysis of post-mortem case reports from Salt River Mortuary was conducted to investigate all deaths in which fires were involved in the west metropole of Cape Town, between 2006 to 2018. Demographic, circumstantial, and toxicological data were analyzed using R software. RESULTS: In total 1370 fire deaths occurred over 13 years, with a mean of 106 (SD ± 18) cases per annum (≈3% of the annual caseload and a mortality rate of 5.5 per 100,000). Males (70.4%), adults (mean=30.7 years), and toddlers (1-4 years old) were notably at risk. Deaths typically occurred in the early morning (00h00 - 06h00) (45.7%), during winter (32.1%), and in lower socioeconomic areas with highly dense informal settlements (65.6%), with 29% of deaths occurring in multi-fatality incidents. Ethanol was detected (≥0.01 g/100 mL) in 55.1% of cases submitted for analysis (71.5%), with a mean of 0.18 g/100 mL, and with 93.8% of positive cases > 0.05 g/100 mL. Carboxyhaemoglobin (COHb) analysis was requested in 76.4% of cases, with 57% of cases having a %COHb of ≥ 20%. Toxicology results (for drugs other than ethanol) from the national laboratory were outstanding in 34.4% of the cases at the conclusion of the study. BAC and %COHb were significantly higher in deaths from burns and smoke inhalation (usually accidents) than deaths from combined trauma and burns (typically homicides). Fire deaths with high COHb levels were more likely to display cherry-red discoloration (OR=3.1) and soot in the airways (OR=2.7) at autopsy. CONCLUSION: This article provides an updated description of fire deaths in the west metropole of Cape Town. The importance of BAC and COHb testing in these cases was noted, and the authors call for an investigation of the role of drug impairment (specifically frequently misused drugs methamphetamine and methaqualone) as a risk factor in these deaths. Areas of high-density informal settlements, where open flames are used to heat, light, and cook, were noted as high risk.

Usefulness of a modified poisoning severity score for predicting prognosis in acute carbon monoxide poisoning.

INTRODUCTION: The poisoning severity score (PSS) was developed to grade the severity of various types of poisoning. However, in its current form, it requires investigating many variables, some of which have been found not to be associated with carbon monoxide (CO) poisoning severity. Therefore, in this study, we modified the PSS for CO poisoning and compared its usefulness to that of the original PSS, as an early prognostic factor of short-term outcome in CO poisoning patients. METHODS: This was a retrospective observational study conducted in patients with CO poisoning who visited the emergency department between January 2014 and December 2020. Patients' primary outcome was their Cerebral Performance Category (CPC) scale score at discharge, which classified those with CPC 1-2 as having a favorable outcome and those with CPC 3-5 as having a poor outcome. We calculated the patients' PSS and their CO-modified PSS by replacing blood and metabolic balance category in the original PSS with carboxyhemoglobin (COHb) and lactate levels, respectively. RESULTS: This study included 891 patients, of which 852 (95.6%) and 39 (4.4%) were classified into the favorable and poor outcome groups, respectively. Using multivariate analysis, the PSS (odds ratio [OR], 22.961; 95% confidence interval [CI], 10.641-49.546; p < 0.001) and CO-modified PSS (OR, 28.856; 95% CI, 12.874-64.679; p < 0.001) were both found to be associated with poor outcomes at hospital discharge. The areas under the receiver operating characteristic curves for the PSS and CO-modified PSS were 0.874 (95% CI, 0.850-0.895) and 0.881 (95% CI, 0.858-0.901), respectively. CONCLUSION: The CO-modified PSS, with fewer variables than the original PSS, was not inferior to predict poor outcomes, and if COHb level is considered together with other parameters, then it can be used both for predicting prognosis and in diagnosis.

Hyperbaric oxygen therapy and mortality from carbon monoxide poisoning: A nationwide observational study.

BACKGROUND: The effects of hyperbaric oxygen therapy (HBOT) on mortality or morbidity in patients with carbon monoxide (CO) poisoning remain unknown. We examined the effects of HBOT on CO poisoning and further strived to delineate its inherent effects on specific subgroups of patients using a nationwide inpatient database. METHODS: We identified adult patients with CO poisoning who were registered in the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2016. Propensity score-matching was performed to compare patients who received HBOT within 1 day of admission (HBOT group) with those who did not receive HBOT (control group). The primary outcome was in-hospital mortality. The secondary outcomes were a depressed mental status and reduced activities of daily living (ADL) at discharge. We also performed subgroup analyses divided according to severity of CO poisoning. RESULTS: Eligible patients were categorized into the HBOT group (n = 2034) or the control group (n = 4701). One-to-one propensity score-matching created 2034 pairs. In-hospital mortality was not significantly different between the HBOT and control groups (0.8% vs. 1.2%, risk difference: -0.4%, 95% confidence interval: -1.0 to 0.2). Patients in the HBOT group had significantly lower proportions of a depressed mental status and reduced ADL at discharge than did those in the control group. Similar associations were shown in the non-severe poisoning subgroup. CONCLUSIONS: Although HBOT was not significantly associated with reduced mortality, it was significantly associated with a favorable consciousness level and ADL in patients with CO poisoning. HBOT may be beneficial even for patients with non-severe CO poisoning.

Mortalities of methamphetamine, opioid, and ketamine abusers in Shanghai and Wuhan, China.

Studies on the mortalities of drug abusers in China are scarce. This study explores the deaths of methamphetamine, opioid, and ketamine abusers in Shanghai (2004-2017) and Wuhan (2005-2017). Chi-square/Fisher's exact tests were used to compare the differences in terms of region, gender, age, cause of death, and the method used in the last drug abuse. Poisson regression models were used to estimate the rate ratios ("RRs") and annual percentage changes ("APCs"). 314 heroin, 43 methamphetamine, and 4 ketamine abusers were included. Furthermore, simultaneously, 6 abusers used heroin and methamphetamine, and 7 abusers used methamphetamine and ketamine. Heroin-related deaths have declined in Shanghai (APC, -16.1; 95 % CI, -18.4 to -11.3) and Wuhan (APC, -16.0; 95 % CI, -18.9 to -10.6), whereas methamphetamine-related deaths have increased in Wuhan (APC, 12.8; 95 % CI, 0.0 to 29.2). On the whole, in the two cities, males were more frequently observed than females in heroin-related deaths (4.4, 230/52). However, the gender ratios for methamphetamine- (1.8, 34/19) and ketamine-related deaths (1.2, 6/5) were close to one. In view of the mortality rates of the drug abusers in most Chinese cities were still unclear, it is thus important to improve mortality surveillance of the drug abusers at the national level.

Atherosclerotic and Hypertensive Cardiovascular Disease are Associated with Death at Sublethal Carboxyhemoglobin Levels: A Postmortem Study.

Residential fires are a significant cause for morbidity and mortality in the United States. Death is often the result of soot and smoke inhalation causing carbon monoxide (CO) toxicity. The approximate lethal level of carboxyhemoglobin (COHb) in healthy adults has been well described. However, a significant number of medical examiner cases involve infirmed decedents, often elderly, with complex cardiovascular disease burdens. It is well known that death in these cases will occur at sublethal levels of COHb; however, increased lethality has been largely documented via anecdotal experience and lacks quantification. Fifty-five cases were identified where death resulted from smoke and soot inhalation suffered in a residential fire. The control group, with no cardiovascular disease, had an age-adjusted mean COHb level of 61.6% at the time of death. Presence of hypertensive cardiovascular disease showed a 30% reduction in COHb (age-adjusted mean 43.2%), atherosclerotic disease showed a 33% reduction (age-adjusted mean 41.5%), and combined disease presentation accounted for 41% reduction (age-adjusted mean 36.3%). When controlling for age, atherosclerotic and hypertensive cardiovascular diseases were each associated with statistically significant decreases in COHb (p < 0.01). Increasing age was associated with decreased COHb levels at 2.8% per 10 years of life (p < 0.01), even when modeled with hypertensive and atherosclerotic disease. These findings carry important public health significance, as well as practical significance for the medical examiner when interpreting COHb levels in cases of suspected deaths due to smoke and soot inhalation.

Pediatric Carbon Monoxide Poisoning in Southern Israel: A Cross-Sectional Study.

OBJECTIVES: This study aimed to describe the epidemiology and clinical burden of unintended carbon monoxide (CO) poisoning among children in the Negev region of southern Israel. METHODS: This was a cross-sectional retrospective study of CO poisoning patients admitted to Soroka University Medical Center in 2011 through 2015. RESULTS: Overall, 43 cases of CO poisoning were recorded among children younger than 18 years. Five patients died, all upon admission. Poisoning due to smoke "per se" and due to CO emitted from heating devices were responsible for 28 (65.1%) and 14 (32.6%) cases, respectively. Eight (18.6%) patients suffered from convulsions, and 13 (43.3%) of 30 evaluable patients complained of headaches. Twenty-two (51.2%) were found unconscious in the field, and 7 (16.3%) were unconscious at examination at the emergency department. The average carboxyhemoglobin level on admission was 10.5% ± 10.4% (level ranging from 0.1% to 46.2%). Treatment included oxygen in 34 patients (79%) and hyperbaric oxygen therapy in 8 patients (19%). No differences were found between Bedouin and Jewish children in sex, age, residence area, source of CO poisoning, symptoms severity, and need for hyperbaric oxygen therapy. More patients with exposure to water heating devices were older than 4 years, lived in villages, and were diagnosed as having loss of consciousness in the field compared with those exposed to smoke inhalation. CONCLUSIONS: Carbon monoxide poisoning in children is frequent in southern Israel. Education about prevention, implementation of safer standards for home heating systems, and government supervision are required management strategies to decrease the CO poisoning incidence in southern Israel.

Incidence Rate and Predictors of Globus Pallidus Necrosis after Charcoal Burning Suicide.

Objective: This study examined predictors of globus pallidus necrosis as there was a paucity of literature of globus pallidus necrosis resulted from carbon monoxide poisoning after charcoal burning suicide. Methods: A total of 67 patients who had attempted charcoal burning suicide were recruited and stratified into two subgroups based on either presence (n = 40) or absence (n = 27) of globus pallidus necrosis. Demographic, clinical, laboratory, and radiographic data were obtained for cross-sectional analysis. All patients were followed to investigate the risks for mortality. Results: The patients aged 36.8 ± 11.1 years (67.2%) were male. Patients with globus pallidus necrosis were younger (p = 0.044) and had less hypertension (p = 0.015) than patients without globus pallidus necrosis. Furthermore, patients with globus pallidus necrosis suffered from severer medical complications, i.e., fever (p = 0.008), acute myocardial injury (p = 0.022), acute rhabdomyolysis (p = 0.022), and neuropsychiatric symptoms (p < 0.001) than patients without globus pallidus necrosis. Moreover, patients with globus pallidus necrosis received less hyperbaric oxygen therapy than without necrosis (p = 0.024). Two patients (3.0%) died on arrival. In a multivariable regression model, it was revealed that acute myocardial injury (odds ratio 4.6, confidence interval 1.1-18.9, p = 0.034) and neuropsychiatric symptoms (odds ratio 8.0, confidence interval 2.0-31.4, p = 0.003), decreased blood bicarbonate level (odds ratio 0.8, confidence interval 0.7-1.0, p = 0.032), and younger age (odds ratio 0.9, confidence interval 0.9-1.0, p = 0.038) were significant predictors for globus pallidus necrosis. Conclusion: Although patients who had attempted charcoal burning suicide had a low mortality rate (3.0%), globus pallidus necrosis was not uncommon (59.7%) in this population. Further studies are warranted.

Prognostic factors of carbon monoxide poisoning in Taiwan: a retrospective observational study.

OBJECTIVES: To identify the risk factors related to the prognosis of carbon monoxide (CO)-poisoned patients in the hospital. DESIGN: Retrospective observational study. SETTING: Tri-Service General Hospital, Taiwan. METHODS: We conducted a review of the medical records of 669 CO-poisoned patients, who were admitted to the Department of Emergency, Tri-Service General Hospital, Taiwan, from 2009 to 2014. Demographic, clinical and laboratory data were collected for analysis. In the study, the end points for poor outcome were patients who either still had sequelae, were bedridden or died after treatment. The independent t-test, χ2 test and binary logistic regression were used to identify the association between the prognostic factors and the outcomes. RESULTS: The logistic regression analysis confirmed that the Glasgow Coma Scale (GCS) score (p=0.008) and blood urea nitrogen (BUN) (p=0.002) were related to poor outcomes. Furthermore, the receiver operating characteristic (ROC) curve showed that the cut-off point of intubation days was 1.5 days (area under the ROC curve [AUC]=0.793) for all patients and 2.5 days (AUC=0.817) for patients with intubation when predicting poor outcomes. CONCLUSION: We identified the factors that most strongly predict the prognosis of CO poisoning, including the GCS score, serum BUN and intubation days. Moreover, the number of hyperbaric oxygen treatments seems to have impact of the outcome.

Effect of Hyperbaric Oxygen on Neurologic Sequelae and All-Cause Mortality in Patients with Carbon Monoxide Poisoning: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND Hyperbaric oxygen (HBO) is used in patients with carbon monoxide (CO) poisoning to prevent the occurrence of delayed neurological sequelae. However, inconsistent results were obtained regarding the treatment effects of HBO. Therefore, the current meta-analysis was conducted based on published randomized controlled trials (RCTs) to determine the effect of HBO on neurologic sequelae and all-cause mortality in patients with CO poisoning. MATERIAL AND METHODS Electronic databases MedLine, EmBase, and the Cochrane Library were searched for relevant RCTs from inception to March 1, 2019. The pooled relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the outcomes by using a random-effects model. Sensitivity, subgroup, and publication bias analyses were also conducted. RESULTS Seven RCTs, including 9 cohorts and a total of 2023 patients with CO poisoning, were enrolled in this study. The summary results revealed that HBO showed an association with lower risk of memory impairment compared to patients receiving normobaric oxygen (NBO), whereas 2 sessions of HBO showed an association with higher risk of memory impairment compared to those who received 1 session of HBO. Moreover, HBO was associated with increased neuropsychologic scores of block design and trail making when compared with NBO. No other significant differences regarding the treatment effects of HBO were observed. CONCLUSIONS These results indicate that HBO therapy significantly reduces the risk of memory impairment compared to NBO, but 2 sessions of HBO might not be better for memory impairment than 1 session of HBO.

Racial and ethnic trends in unintentional carbon monoxide poisoning deaths.

OBJECTIVE: Government programs have attempted to impact a recognized elevated risk for carbon monoxide (CO) poisoning among minority racial and ethnic groups. This study sought to describe U.S. mortality due to unintentional, non-fire-related CO poisoning, examining the distribution and trends by race and ethnicity. METHODS: CDC Wonder was used to extract and analyze data on all U.S. resident deaths from unintentional CO poisoning from 2000-2017, categorizing them by year, race, ethnic origin and gender. RESULTS: The absolute number of unintentional CO deaths decreased from about 450 to 380 per year during the period studied, a number near totally accounted for by the decrease in deaths occurring among non-Hispanic/Latino whites. The number of deaths among the remainder of the population did not significantly change. However, greater growth in minority populations resulted in a similar decline in the mortality rate between non-Hispanic/Latino whites and the combined minority population. The decline in combined minority death rate resulted from a decrease in the Hispanic/Latino white rate. Death rate did not decline in the black or African American population. CONCLUSIONS: All minority groups continue to display a disproportionate number of unintentional non-fire-related CO poisoning deaths compared to non-Hispanic/Latino whites. The decrease in U.S. deaths from unintentional non-fire-related carbon monoxide poisoning from 2000-2017 is accounted for by a decrease in non-Hispanic/Latino white deaths. While numbers of such deaths among minority groups have not changed since 2000, increases in the size of minority populations have resulted in a declining crude death rate for Hispanic/Latino whites.

Development and Evaluation of a Theory-Based Approach to Reducing Carbon Monoxide (CO) Morbidity and Mortality: The CO Blitz Model.

Carbon monoxide (CO) poisoning is preventable yet remains the most common cause of U.S. non-drug poisoning. The purpose of this non-experimental study was to develop and evaluate the theory-based CO Blitz Model. Events targeted five SC communities; volunteers provided education while local firefighters installed CO alarms. At the 4-6-month follow-up evaluation, all homes still had a functioning CO alarm; most recipients could name CO sources in their homes (78%) and what to do if the alarm sounded (90%). The theory-driven process evaluation revealed the CO Blitz Model was tailorable and effective in addressing unique community resources and needs.

Co-morbidities in the multiple victims of the silent killer in carbon monoxide poisoning.

Carbon monoxide (CO) remains an insidious and silent killer due to its physical and chemical properties; its lethal effects are encountered in cases of household accidents, occupational hazards or suicide. Deaths due to CO poisoning were studied retrospectively in the period 2000-2018 at the Institute of Forensic Medicine, Timisoara, Romania. These cases represent 1.75% of all the autopsies and 0.63% of all violent deaths. There have been cases of single deaths and cases with multiple victims - concomitant deaths. The analysis of lethal CO intoxication cases that occurred in different circumstances (incomplete burning with CO accumulation, fires - associated with burns, death in the fountain - due to fossil fuel pump failure, suicide due to exhaust gases) was based on the examination of 298 autopsy files. In this type of poisoning, the forensic examination of the body is marked by the non-specific character of most of the macroscopic and microscopic changes. Although inconstant, these types of changes (e.g., red discoloration of livor mortis) raise the suspicion of death by CO poisoning; the essential contribution to establishing cause of death resides in the determination of carboxyhemoglobin (COHb) concentration by spectroscopy. In all cases, the cerebral and cardio-pulmonary modification and their contribution to the cause of death were studied. Co-morbidities interfere with the cause of death in cases with average COHb concentrations, in the 20-50% range, where CO blood levels alone are not reason enough to explain the onset of death.

Carbon Monoxide Exposure and Poisoning Cases in Wisconsin, 2006-2016.

INTRODUCTION: Carbon monoxide (CO) poisoning is responsible for over 450 deaths and 21,000 Emergency Department visits annually in the United States. In Wisconsin, multiple large-scale CO poisoning events have occurred in recent years. This analysis explores trends in CO exposure events in the state from 2006 through 2016. METHODS: Wisconsin Poison Center (WPC) CO exposure data from January 1, 2006 through December 31, 2016 was analyzed for trends over time. CO poisoning cases were classified using the Council of State and Territorial Epidemiologists case definition. RESULTS: During the study period, 3,703 persons were exposed to CO and 2,148 were poisoned. On average, 337 persons were exposed annually over this period, with an annual average of 195 suspected and probable poisoning cases per year, as reported to the WPC. Large-scale events ( ≥ 5 persons) accounted for 4.8% (n = 104) of all events. Using data extracted from WPC case notes for large-scale exposures, the most common source of exposure was furnaces or water heaters (20.2%; n = 21) followed by fire (8.7%; n = 9). CONCLUSIONS: Despite public health efforts to reduce CO exposures, CO poisoning continues to affect Wisconsin residents. Efforts to prevent large scale CO poisonings should focus on awareness of CO exposure within the home, as well as the risk in public or occupational settings. Moreover, these efforts should focus on improving the use of CO detectors in all settings to prevent exposure. The WPC can be used as a resource for clinicians in cases of CO exposure and poisoning.

Epidemiology and forensic aspects of carbon monoxide intoxication in Portugal: A three years' analysis.

The presented manuscript describes the carbon monoxide (CO) related deaths in Portugal over a period of 3 years, based on autopsies carried out at the National Institute of Legal Medicine and Forensic Sciences, from January 2012 to December 2014. Three hundred and forty-seven forensic autopsy reports with carboxyhaemoglobin (COHb) analysis requests were analysed and subdivided into three main groups: (1) improbable CO intoxication; (2) possible CO intoxication; (3) highly probable CO intoxication. In group 1, COHb analysis was negative, and the death circumstances, as well as the post mortem findings, didn't corroborate an exposition to CO. In group 2, with COHb positive in 1/3 of the cases, the death circumstances corroborated an exposition to CO, but the post mortem findings weren't enough to confirm an exposition to this substance. In group 3, the results of COHb were positive, and both circumstances of death and post mortem findings corroborated an exposition to CO. The first group (113 cases) had no specific suspicion of a CO intoxication and, thus, the request of a COHb analysis had no particular basis, reflected in the low COHb achieved percentage (between 0 and 12). In the second group (164 cases), 29% of the cases were directly or indirectly related to CO exposure (between 0% and 94%). In the third group (70 cases), 56 deaths were due to CO intoxication and 14 due to burns after CO inhalation (between 18% and 91%). This study intended to do, not only a 3-year assessment of CO poisoning, but also to enhance the fact that circumstantial information, as well as a correct evaluation at the forensic autopsy data are crucial, and allow an enhanced diagnosis of possible intoxication, as well as a better guidance for the consequent toxicological analysis requests.

Poison severity score and sequential organ failure assessment score: Carbon monoxide poisoning prognosis.

PURPOSE: We aimed to examine the utility of the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) score as early prognostic predictors of short-term outcomes in patients with carbon monoxide (CO) poisoning. We hypothesized that both the PSS and the SOFA score would be useful prognostic tools. METHODS: This was retrospective observational study of patients with CO poisoning who presented to the emergency department and were admitted for more than 24 hours. We calculated PSS, the initial SOFA score, a second (2nd) SOFA score, and a 24-hour delta SOFA score. The primary outcome was reported as the cerebral performance category (CPC) scale score at discharge. We classified those with CPC 1-2 as the good outcome group and those with CPC 3-5 as the poor outcome group. RESULTS: This study included 192 patients: 174 (90.6%) belonged to the good outcome group, whereas 18 (9.4%) belonged to the poor outcome group. The PSS (1.00 [0.00, 1.00] vs 3.00 [3.00, 3.00], p < 0.001), initial SOFA (1.00 [0.00, 2.00] vs 4.00 [3.25, 6.00], p < 0.001), 2nd SOFA score (0.00 [0.00, 1.00] vs 4.00 [3.00, 7.00], p < 0.001), and 24-hour delta SOFA score (-1.00 [-1.00, 0.00] vs 0.00 [-1.00, 1.00], p = 0.047) of the good outcome group were significantly higher than those of the poor outcome group. The areas under the receiver operating characteristic curve for PSS and the initial SOFA and 2nd SOFA scores were 0.977 (95% confidence interval [CI] 0.944-0.993), 0.945 (95% CI 0.903-0.973), and 0.978 (95% CI 0.947-0.994), respectively. CONCLUSION: The PSS, initial SOFA score, and 2nd SOFA score predict acute poor outcome accurately in patients with CO poisoning.

A retrospective study of poisoning deaths from forensic autopsy cases in northeast China (Liaoning).

Acute poisoning is a public health threat that leads to morbidity and mortality worldwide. In this retrospective study, we evaluated autopsies from deaths caused by acute poisoning from 2008 to 2017 at the School of Forensic Medicine, China Medical University (SFMCMU) in the Liaoning Province, northeast China. A total of 140 poisoning deaths were investigated and the demographic characteristics, causes and manner of death, toxics category were analyzed. The number of poisoning deaths gradually increased during the study period. The majority of poisoning deaths were accidents (66.43%), followed by suicides (27.86%), and homicides (3.57%). Of the 140 cases, 47 (33.57%) were caused by drugs, 38 (27.14%) by agrochemicals (mainly organophosphate pesticides, n = 16), 37 (26.43%) by respiratory dysfunction toxics (mainly carbon monoxide, n = 21), and 9 (6.43%) by poisonous plants and animals. Alcohol/methanol (5, 3.57%) and other chemicals (4, 2.86%) accounted for the remaining cases. The present study provides poisoning distribution in the Liaoning province and highlights implications for public health policy and prevention efforts in northeast China.

Deaths by poisoning in New Zealand, 2008-2013.

Introduction: While a number of developed countries have witnessed a decline in carbon monoxide (CO) deaths and increasing numbers of opioid-related fatalities, it is not known whether these or other trends have occurred in New Zealand. The aim of this study was, therefore, to review deaths due to poisoning in New Zealand, describe the causative substances, and identify any trends. Methods: Retrospective study reviewing New Zealand's poison-related death findings recorded in the National Coronial Information System (NCIS) database over the 6-year period 2008-2013. Results: We identified 1402 poisoning-related deaths recorded in the NCIS database representing a mortality rate of 5.4 deaths/100,000 population per year. The mortality rate due to poisoning was higher in males (6.96/100,000) than females (3.83/100,000). Fatalities peaked in the 40-50-year age group with the highest proportion of intentional deaths occurring in people aged 80-90 years. Pharmaceuticals accounted for 731 fatalities (52%) and chemicals 431 (31%), with multiple exposures occurring in 399 cases (28.5%). While CO was the leading cause of death throughout the period (n = 303, 21.6%), there was a significant reduction in the rate of CO fatalities from 1.69/100,000 population in 2008 to 0.94/100,000 in 2013 (IRR (95% CI) 2013/2008 0.56 (0.37-0.83)). There was, however, no statistically significant change in either the opioid-related death rate or the total number of deaths. Methadone was the leading pharmaceutical cause of fatality and the third most common cause overall, followed by morphine and codeine, with zopiclone and clozapine equally ranked as the sixth most common cause. Conclusion: While New Zealand has not suffered an "opioid epidemic" and has experienced a significant decline in CO deaths, the overall death rate due to poisoning has remained high. The development of accessible, timely, and relevant toxicovigilance systems would support the early implementation of interventions to reduce the leading causes of fatal poisoning.

Carbon monoxide poisoning in Denmark with focus on mortality and factors contributing to mortality.

INTRODUCTION: Carbon monoxide (CO) poisoning is frequent worldwide but knowledge regarding the epidemiology is insufficient. The aim of this study was to clarify the extent of this intoxication, its mortality and factors associated with mortality. MATERIALS AND METHODS: National databases from Statistics Denmark were used to identify individuals who suffered from CO-poisoning during 1995-2015, as well as information regarding co-morbidities, mortality and manner of death. RESULTS: During the period from 1995 to 2015, 22,930 patients suffered from CO-poisoning in Denmark, and 21,138 of these patients (92%) were hospitalized. A total of 2,102 patients died within the first 30 days after poisoning (9.2%). Among these, 1,792 (85% of 2,102) were declared dead at the scene and 310 (15% of 2,102) died during hospitalization. Deaths due to CO-poisoning from smoke were intentional in 6.3% of cases, whereas deaths due to CO containing gases were intentional in 98.0% of cases. Among patients who survived >30 days, there was no significant difference in survival when comparing hyperbaric oxygen therapy (HBO) treatment with no HBO treatment after adjustment for age and co-morbidities such as drug abuse, psychiatric disease, stroke, alcohol abuse, arterial embolism, chronic obstructive pulmonary disease, cerebrovascular disease and atrial fibrillation. Several co-morbidities predicted poorer outcomes for patients who survived the initial 30 days. CONCLUSIONS: Poisoning from smoke and/or CO is a frequent incident in Denmark accounting for numerous contacts with hospitals and deaths. Both intoxication and mortality are highly associated with co-morbidities interfering with cognitive and physical function. Treatment with HBO was not seen to have an effect on survival.

Mapping of carbon monoxide related death risk in Turkey: a ten-year analysis based on news agency records.

BACKGROUND: Carbon-monoxide (CO) poisoning is a substantial cause of preventable mortality. In Turkey, no nationwide data are being collected nowadays. In our study, we aimed to assess the trend in deaths related to CO exposure in all provinces of Turkey in a 10-year period by using the records of a news agency which collects the news from the majority of the national newspapers, local newspapers and television channels. METHODS: In this study, 27,881 news items that were released between January 2008 to December 2017 which included keywords of "poisoning" and "death" or "carbon monoxide" and "death" were evaluated. 2667 non-fire related deaths were used in the final analyses. RESULTS: In a 10-year period, the risk of CO-related death in Turkey was 0.35/100000. 1371 (51.4%) of the victims were male and the median age of the patients was 45 years (range, 15 days-108 years). Most of the deaths occurred ≥50 years of age. Stoves were the predominant source [n = 2096 (78.6%)]. There was a stagnating trend of CO-related deaths. Most of the incidents occurred in winter. The Middle Anatolian region was of the highest risk in CO-related mortality. CONCLUSIONS: In conclusion, CO poisoning is still a considerable public health concern in Turkey. Results of our study showed that stoves are still frequently being used and are the cause of death especially in rural areas with lower socioeconomic status. A better organized, nationwide surveillance and management approaches are needed to demonstrate the true burden CO related morbidity and mortality as well as its prevention in Turkey.

National unintentional carbon monoxide poisoning estimates using hospitalization and emergency department data.

Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the US and a preventable cause of death. We generated national estimates of accidental CO poisoning and characterized the populations most at risk. UNFR CO poisoning cases were assessed using hospitalization and emergency department (ED) data from the Healthcare Costs and Utilization Project National Inpatient Sample and Nationwide Emergency Department Sample databases. We used hospitalization data from 2003 to 2013 and ED data from 2007 to 2013. We calculated trends using a linear regression of UNFR CO poisonings over the study period and age-adjusted rates using direct standardization and U.S. Census Bureau estimates. During 2003-2013, approximately 14,365 persons (4.1 cases/million annually) with confirmed or probable UNFR CO poisoning were admitted to hospitals and the annual rate of poisonings showed a weak downward trend (p = 0.12). During 2007-2013, approximately 101,847 persons (48.3 visits/million annually) visited the ED and the annual rate of poisonings showed a significant downward trend (p ≤ 0.01). Most UNFR CO hospital cases involved patients who were older (aged 45-64 years), white, male, or living in the South or Midwest. Overall, the rate of hospitalizations did not change over the study period. Unintentional CO poisoning is preventable and these cases represent the most recent national estimates. ED visits declined over the study period, but the hospitalization rates did not change. This emphasizes the need for prevention efforts, such as education in the ED setting, increased use of CO alarms, and proper use and maintenance of fuel-powered household appliances.