Diagnostic utility of capnography in emergency department triage for screening acidemia: a pilot study

Paul Peng; Alex F Manini

doi:10.1186/s12245-024-00631-3

Diagnostic utility of capnography in emergency department triage for screening acidemia: a pilot study

Int J Emerg Med. 2024 Apr 22;17(1):57. doi: 10.1186/s12245-024-00631-3.

Authors

Paul Peng¹, Alex F Manini²

Affiliations

¹ Department of Emergency Medicine, The State University of New Jersey, 08901, Rutgers, New Brunswick, NJ, United States of America. paul.peng@rutgers.edu.
² Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, United States of America.

Abstract

Background: Capnography is a quantitative and reliable method of determining the ventilatory status of patients. We describe the test characteristics of capnography obtained during Emergency Department triage for screening acidemia.

Results: We performed an observational, pilot study of adult patients presenting to Emergency Department (ED) triage. The primary outcome was acidemia, as determined by the basic metabolic panel and/or blood gas during the ED visit. Secondary outcomes include comparison of estimated and measured respiratory rates (RR), relationships between end-tidal CO₂ (EtCO₂) and venous partial pressure of CO₂, admission disposition, in-hospital mortality during admission, and capnogram waveform analysis. A total of 100 adult ED encounters were included in the study and acidemia ([Formula: see text] or [Formula: see text]) was identified in 28 patients. The measured respiratory rate (20.3 ± 6.4 breaths/min) was significantly different from the estimated rate (18.4 ± 1.6 breaths/min), and its area under the receiver operating curve (c-statistic) to predict acidemia was only 0.60 (95% CI 0.51-0.75, p = 0.03). A low end-tidal CO₂ (EtCO₂ < 32 mmHg) had positive (LR+) and negative (LR-) likelihood ratios of 4.68 (95% CI 2.59-8.45) and 0.34 (95% CI 0.19-0.61) for acidemia, respectively-corresponding to sensitivity 71.4% (95% CI 51.3-86.8) and specificity 84.7% (95% CI 74.3-92.1). The c-statistic for EtCO₂ was 0.849 (95% CI 0.76-0.94, p = 0.00). Waveform analysis further revealed characteristically abnormal capnograms that were associated with underlying pathophysiology.

Conclusions: Capnography is a quantitative method of screening acidemia in patients and can be implemented feasibly in Emergency Department triage as an adjunct to vital signs. While it was shown to have only modest ability to predict acidemia, triage capnography has wide generalizability to screen other life-threatening disease processes such as sepsis or can serve as an early indicator of clinical deterioration.

Keywords: Acidemia; Capnography; End-tidal CO2; Respiration; Vital signs.