Screening for carbon monoxide (CO) poisoning by general practitioners in home visits

To evaluate the interest of carbon monoxide (CO) detector used by general practionners visiting patients at home. CO detector (cost: 200 euros) was attributed to 300 general practionners visiting at least 20 patients at home per week. Alarm was triggered when ambient CO concentration exceeded 80ppm. Measurement of CO in expired breath was also possible. Activity and alarms were prospectively collected. Circumstances of intoxication were recorded. Evaluation was finally performed. The end-poind was to quantify CO-poisoning detected by the use of the device and the cost of this stratégy. From November 2001 to November 2004, 65 scenes of intoxication with 79 victims were prospectively reported by 12 general practionners. Final evaluation revealed that 23 physicians omitted to declare alarms. Alarm incidence was of 1 for 17.527 visits; with a related cost of approximately 858 euros for 24 months. Ambient carbon monoxide concentration exceeded 200ppm in 25% of cases. Hospital admission was required for 91% of the victims. Hyperbaric oxygen therapy was performed in two cases. General practionners (n=272) considered that CO detector was useful for safety reasons (91%), they wanted to continue the experience, but did not plan to buy such device (59%). Use of CO detectors by general practionners visiting patients at home allowed to identify 65 scenes of CO intoxication. In most cases, the cause of the visit did not suggested CO poisoning. The cost of the device seems to limits its large use. CO detector is a safety tool for both general prationners and patients. Its large use has to be questioned.