PC2128: Carbon Monoxide Exposures Among Children in Public Indoor Ice Arenas as Reported to Pennsylvania and Delaware Poison Control Centers, 2012-2021

Background: Carbon monoxide (CO) poisoning results in >50,000 U.S. emergency department (ED) visits yearly. Most cases arise from house fires, furnace dysfunction, or under-ventilated home use of gas engines; risks in ice arenas may be under-appreciated and monitoring of CO emissions from combustion ice-resurfacing equipment is not federally regulated. Three states, Minnesota, Massachusetts, and Rhode Island, have policies that define air sampling, record-keeping, and corrective measure requirements. To advocate for regional CO-related injury prevention, we sought to define the epidemiology of pediatric CO poisoning injury at indoor ice arenas, as reported to poison centers (PCCs) from Pennsylvania (PA) and Delaware (DE) over 10 years.

Methods: This is a retrospective, descriptive cohort study. Cases aged 0 – 18 years concerning CO poisoning in public spaces (AAPCC generic code 0106000; exposure site = "public area") reported to PCCs in PA and DE from January 1, 2012, to December 31, 2021 were retrieved. Two investigators redundantly reviewed narrative notes and selected cases occurring in ice arenas for inclusion. Discrete data variables were tabulated and two reviewers abstracted narrative notes using standardized data fields. The demographic and clinical characteristics, treatments, and outcomes were summarized using descriptive statistics.

Results: From review of 169 retrieved records, 24 pediatric subjects (PA - 23, DE - 1) from 7 distinct CO exposure events were eligible. The ages ranged from 20 months to 18 years [median 13 years; IQR 12-14 years]; all events happened in the fall or winter and 93% happened between Friday and Sunday. 19/24 (79%) were male; the majority described as hockey players. Between 1 and 8 individual cases were reported per exposure event. Seventeen subjects (71%) were evaluated in an ED with recorded carboxyhemoglobin (COHb) levels and had maximum values from 3.2 - 19.0% [median 13%, IQR 7.5 - 15.5%], although a minority presented < 4 hours after exposure. The most commonly reported symptoms were headache (69%), nausea (48%) and dizziness (28%). It was noteworthy that 21% of subjects reported both peripheral neuropathic symptoms and musculoskeletal pain. Additional reported symptoms included fainting (1), shortness of breath, fatigue, and abdominal pain andchest pain. All subjects treated in an ED were given supplemental oxygen and one received hyperbaric oxygen; no deaths were reported.

Conclusion: Youth activities in enclosed ice arenas pose risk for mass CO exposure. Most children reported to PA or DE PCCs were symptomatic and received supplemental oxygen during ED evaluation. One in five subjects within this cohort reported atypical symptoms suggesting peripheral neuropathy. This data underestimates actual exposure burden due to under-recognition and voluntary reporting; some exposed individuals from captured events were known to have utilized other state PCCs. Epidemiological description of CO exposures within ice arenas will inform public health advocacy with a goal toward prevention.