TY - JOUR AU - Oda, Gina AU - Ryono, Russell AU - Lucero-Obusan, Cynthia A. AU - Schirmer, Patricia AU - Holodniy, Mark PY - 2017/05/02 Y2 - 2024/03/28 TI - Carbon Monoxide Poisoning in the Veterans Health Administration, 2010 - 2016 JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Non-Infectious Disease Surveillance Use Cases DO - 10.5210/ojphi.v9i1.7710 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7710 SP - AB - <div style="left: 72px; top: 284.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08137);" data-canvas-width="51.022666666666666">Objective</div><div style="left: 84px; top: 296.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01359);" data-canvas-width="304.8372">To describe characteristics of Veterans Health Administration</div><div style="left: 72px; top: 309.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0335);" data-canvas-width="317.509">(VHA) patients with ICD 9/10 CM inpatient discharge and/or</div><div style="left: 72px; top: 323.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02162);" data-canvas-width="315.64693333333344">emergency department (ED)/urgent care outpatient encounter codes</div><div style="left: 72px; top: 336.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00128);" data-canvas-width="171.5526666666667">for carbon monoxide (CO) poisoning.</div><div style="left: 72px; top: 361.94px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.11794);" data-canvas-width="66.10733333333333">Introduction</div><div style="left: 84px; top: 373.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986627);" data-canvas-width="302.4503999999999">It is estimated that in the United States (US), unintentional non-fire</div><div style="left: 72px; top: 387.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.97616);" data-canvas-width="314.3073333333333">related CO poisoning causes an average of 439 deaths annually, and in</div><div style="left: 72px; top: 400.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.999116);" data-canvas-width="314.6881333333333">2007 confirmed CO poisoning cases resulted in 21,304 ED visits and</div><div style="left: 72px; top: 413.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02741);" data-canvas-width="315.6900000000001">2,302 hospitalizations (71 per million and 8 per million population,</div><div style="left: 72px; top: 427.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0032);" data-canvas-width="58.536666666666676">respectively)</div><div style="left: 130.526px; top: 427.534px; font-size: 6.8px; font-family: serif;">1</div><div style="left: 133.926px; top: 427.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00097);" data-canvas-width="252.81266666666662">. Despite the significant risk of morbidity and mortality</div><div style="left: 72px; top: 440.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03744);" data-canvas-width="315.452">associated with CO poisoning, existing surveillance systems in the</div><div style="left: 72px; top: 453.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02089);" data-canvas-width="315.2332666666666">United States are limited. This study is the first to focus specifically</div><div style="left: 72px; top: 467.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00147);" data-canvas-width="237.99999999999994">on CO poisoning trends within the VHA population.</div><div style="left: 72px; top: 492.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.07312);" data-canvas-width="46.59133333333333">Methods</div><div style="left: 84px; top: 504.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.08805);" data-canvas-width="213.112">Queries were performed in VA Praedico</div><div style="left: 297.232px; top: 504.867px; font-size: 6.8px; font-family: serif; transform: scaleX(1.03636);" data-canvas-width="10.5536">TM</div><div style="left: 307.791px; top: 504.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.09184);" data-canvas-width="83.03480000000002">Public Health</div><div style="left: 72px; top: 517.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.972264);" data-canvas-width="316.0345333333335">Surveillance System for inpatient discharges and emergency room</div><div style="left: 72px; top: 531.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.949032);" data-canvas-width="316.04359999999997">and urgent care outpatient visits with ICD 9/10 CM codes for CO</div><div style="left: 72px; top: 544.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.961616);" data-canvas-width="315.87473333333327">poisoning from 1/1/2010 – 6/30/2016. A dataset of unique patient</div><div style="left: 72px; top: 557.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.995009);" data-canvas-width="314.55553333333336">encounters with CO poisoning was compiled and further classified as</div><div style="left: 72px; top: 571.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.975009);" data-canvas-width="313.93673333333334">accidental, self-harm or unspecified. Patients with carboxyhemoglobin</div><div style="left: 72px; top: 584.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02877);" data-canvas-width="165.495">(COHb) blood level measurements</div><div style="left: 237.592px; top: 584.567px; font-size: 11.3333px; font-family: serif;">≥</div><div style="left: 243.863px; top: 584.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03911);" data-canvas-width="24.523066666666665">10%</div><div style="left: 268.38px; top: 584.867px; font-size: 6.8px; font-family: serif;">2</div><div style="left: 271.81px; top: 584.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04392);" data-canvas-width="115.71900000000001">for the same timeframe</div><div style="left: 72px; top: 597.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0889);" data-canvas-width="318.99366666666674">were extracted and merged with the CO poisoning dataset.</div><div style="left: 72px; top: 611.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.975029);" data-canvas-width="315.8769999999999">We analyzed for demographic, geographic and seasonal variables.</div><div style="left: 72px; top: 624.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.989796);" data-canvas-width="316.61933333333343">Rates were calculated using total unique users of VHA care for</div><div style="left: 72px; top: 637.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00215);" data-canvas-width="268.15799999999996">matching time frame and geographic area as denominators.</div><div style="left: 72px; top: 663.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08488);" data-canvas-width="40.93600000000001">Results</div><div style="left: 84px; top: 675.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.999159);" data-canvas-width="302.6951999999998">There were a total of 671 unique VHA patients identified with CO</div><div style="left: 72px; top: 688.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.96857);" data-canvas-width="316.20566666666673">poisoning. Of these, 298 (44%) were classified as accidental, 104</div><div style="left: 72px; top: 701.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.952766);" data-canvas-width="315.61973333333333">(15%) self-harm, and 269 (40%) unspecified. A total of 6 patients</div><div style="left: 72px; top: 715.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.97203);" data-canvas-width="316.3473333333336">died within 30 days of their coded diagnosis, however only 1 of</div><div style="left: 72px; top: 728.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03292);" data-canvas-width="315.384">these was directly attributable to CO poisoning. The overall rate of</div><div style="left: 72px; top: 741.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03111);" data-canvas-width="315.6412666666665">CO poisoning over the study time frame was 18 per million unique</div><div style="left: 72px; top: 755.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.978209);" data-canvas-width="316.4017333333335">users of VHA care. CO poisoning diagnoses were obtained from</div><div style="left: 72px; top: 768.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03916);" data-canvas-width="315.47126666666674">396 (59%) outpatients, 216 (32%) inpatients, and 59 (9%) patients</div><div style="left: 72px; top: 781.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01439);" data-canvas-width="317.1655999999997">with both and outpatient visit and inpatient admission. Patients</div><div style="left: 72px; top: 795.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.95052);" data-canvas-width="315.9212">with self-harm classification were less likely to be seen in the ED</div><div style="left: 72px; top: 808.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.996472);" data-canvas-width="314.68586666666675">(only 24 (6%) unique patients compared to 190 (48%) accidental and</div><div style="left: 72px; top: 821.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.985048);" data-canvas-width="314.42746666666665">182 (46%) unspecified classifications). Of patients seen in the ED and</div><div style="left: 72px; top: 835.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02658);" data-canvas-width="315.5868666666662">subsequently admitted, patients with the classification of accidental</div><div style="left: 72px; top: 848.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.965838);" data-canvas-width="316.0866666666665">poisoning made up the largest percentage with 36 unique patients</div><div style="left: 72px; top: 861.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00692);" data-canvas-width="314.9816666666667">(61%). There were 71 (11%) females compared to 600 (89%) males.</div><div style="left: 72px; top: 875.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.974485);" data-canvas-width="314.5476">The highest represented age group was 45-64 with 342 unique patients</div><div style="left: 72px; top: 888.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.968307);" data-canvas-width="316.2328666666666">(51%). Rates by US Census Region were highest in the Midwest</div><div style="left: 72px; top: 901.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.981876);" data-canvas-width="316.2623333333333">and Northeast (27 and 23 per million unique users, respectively)</div><div style="left: 72px; top: 915.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986911);" data-canvas-width="316.7655333333334">compared to the West and South (15 and 13 per million unique</div><div style="left: 72px; top: 928.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02168);" data-canvas-width="315.51093333333336">users, respectively) (Figure 1). Accidental CO poisonings showed a</div><div style="left: 72px; top: 941.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04078);" data-canvas-width="315.6163333333328">seasonal pattern with peaks occurring in late fall, winter, and early</div><div style="left: 408px; top: 283.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.969516);" data-canvas-width="316.0300000000001">spring months (Figure 2). CO poisonings classified as unspecified</div><div style="left: 408px; top: 296.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04004);" data-canvas-width="315.60046666666665">had a similar but less pronounced pattern, while those classified as</div><div style="left: 408px; top: 309.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.98008);" data-canvas-width="314.47506666666675">self-harm were too few to observe any pattern over time. COHb blood</div><div style="left: 408px; top: 323.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.990602);" data-canvas-width="28.909066666666664">levels</div><div style="left: 436.381px; top: 323.234px; font-size: 11.3333px; font-family: serif;">≥</div><div style="left: 442.54px; top: 323.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.97281);" data-canvas-width="279.8936666666668">10% were present in 111 (17%) of patients with CO poisoning</div><div style="left: 408px; top: 336.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.996969);" data-canvas-width="183.92413333333334">codes. Of patients with COHb measures</div><div style="left: 591.91px; top: 336.567px; font-size: 11.3333px; font-family: serif;">≥</div><div style="left: 598.13px; top: 336.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.99605);" data-canvas-width="124.5726">10%, those with self-harm</div><div style="left: 408px; top: 349.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.983435);" data-canvas-width="314.1747333333333">classification were least represented with only 7 unique patients (6%).</div><div style="left: 408px; top: 363.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02667);" data-canvas-width="315.65033333333304">Accidental and unspecified classifications were equally represented</div><div style="left: 408px; top: 376.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00441);" data-canvas-width="265.02999999999986">with 53 (48%) and 51 (46%) unique patients, respectively.</div><div style="left: 408px; top: 401.94px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.10259);" data-canvas-width="68.01133333333334">Conclusions</div><div style="left: 420px; top: 413.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03541);" data-canvas-width="303.5995999999999">The impact of CO poisoning on the VHA patient population has</div><div style="left: 408px; top: 427.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.960606);" data-canvas-width="316.0073333333335">not been well studied. The geographic distribution of the majority</div><div style="left: 408px; top: 440.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01569);" data-canvas-width="315.23666666666645">of cases in the Midwest and Northeast, and the seasonal distribution</div><div style="left: 408px; top: 453.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.955964);" data-canvas-width="315.96200000000016">of accidental cases in colder months seems to be appropriate with</div><div style="left: 408px; top: 467.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.970872);" data-canvas-width="316.132">respect to what is known of unintentional CO poisoning as often</div><div style="left: 408px; top: 480.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.989343);" data-canvas-width="185.7986666666667">associated with heat-generating sources</div><div style="left: 593.783px; top: 480.867px; font-size: 6.8px; font-family: serif;">3</div><div style="left: 597.231px; top: 480.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.962035);" data-canvas-width="126.684">. Opportunities for further</div><div style="left: 408px; top: 493.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.990133);" data-canvas-width="314.43313333333333">investigation include how potential CO poisoning cases are evaluated</div><div style="left: 408px; top: 507.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0419);" data-canvas-width="315.6435333333333">in VHA given the low percentage of cases with COHb blood level</div><div style="left: 408px; top: 520.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00254);" data-canvas-width="67.67133333333332">measurements.</div> ER -