J Korean Soc Clin Toxicol.  2016 Dec;14(2):115-121. 10.22537/jksct.2016.14.2.115.

Incidence and Features of Cognitive Dysfunction Identified by Using Mini-mental State Examination at the Emergency Department among Carbon Monoxide-poisoned Patients with an Alert Mental Status

• Youk H
• Cha YS
• Kim H
• Kim SH
• Kim JH
• Kim OH
• Kim HI
• Cha KC
• Lee KH
• Hwang SO

• KMID: 2368186
• DOI: http://doi.org/10.22537/jksct.2016.14.2.115

Abstract

PURPOSE
Because carbon monoxide (CO)-intoxicated patients with an alert mental status and only mild cognitive dysfunction may be inadequately assessed by traditional bedside neurologic examination in the emergency department (ED), they may not receive appropriate treatment.
METHODS
We retrospectively investigated the incidence and features of cognitive dysfunction using the Korean version of the Mini-Mental State Examination (MMSE-K) in ED patients with CO poisoning with alert mental status. We conducted a retrospective review of 43 consecutive mild CO poisoned patients with a Glasgow Coma Scale score of 15 based on documentation by the treating emergency physician in the ED between July 2014 and August 2015.
RESULTS
Cognitive dysfunction, defined as a score of less than 24 in the MMSE-K, was diagnosed in six patients (14%) in the ED. In the MMSE-K, orientation to time, memory recall, and concentration/calculation showed greater impairments. The mean age was significantly older in the cognitive dysfunction group than the non-cognitive dysfunction group (45.3 yrs vs. 66.5 yrs, p<0.001). Among the initial symptoms, experience of a transient change in mental status before ED arrival was significantly more common in the cognitive dysfunction group (32.4% vs. 100%, p=0.003).
CONCLUSION
Patients with CO poisoning and an alert mental status may experience cognitive dysfunction as assessed using the MMSE-K during the early stages of evaluation in the ED. In the MMSE-K, orientation to time, memory recall, and concentration/calculation showed the greatest impairment.

Keyword

Carbon monoxide; Cognitive disorder; Emergency care

MeSH Terms

Carbon Monoxide
Carbon*
Emergencies*
Emergency Medical Services
Emergency Service, Hospital*
Glasgow Coma Scale
Humans
Incidence*
Memory
Neurologic Examination
Poisoning
Retrospective Studies
Carbon
Carbon Monoxide