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Power outages substantially increased risk for pediatric emergency department visits for carbon monoxide poisoning in New York State, according to research.

Power outages substantially increased risk for pediatric emergency department (ED) visits for carbon monoxide (CO) poisoning in New York State (NYS), according to a study published online ahead of print in Pediatrics.

“Power outages should be regarded as an important CO poisoning risk factor,” wrote corresponding author Alexander J. Northrop, MD, MS, of the Children’s Hospital of Philadelphia, and colleagues. The investigation spanned 2017 to 2020 and evaluated the relationship between community‐scale power outages and CO poisoning–related ED visits among children aged 17 years and younger in NYS.

Scale of Outages & Associated Risk

Researchers distinguished between all-scale outages—defined as 1% or more of a community without power—and large-scale outages, in which an outage affects 20% or more of a community. Over the 4‐year period, 917 pediatric CO poisonings were recorded (incidence 5.6 per 100,000 person-years). During large‐scale outages, just 4 hours without power increased the odds of an ED visit for CO poisoning by more than 150%. Even smaller, all-scale outages elevated the risk by at least 50%.

The authors suggested that spikes after extreme weather-related power outages were likely due to improper generator use. “Children are especially vulnerable after extreme weather‐related power outages,” the authors noted, underscoring the need to address generator safety and indoor CO accumulation.

Demographics, Seasonality, & Geography

The researchers reported that incidence rates were disproportionately higher among younger children and certain racial groups. Children aged 5 years or younger experienced the highest rates (7.8 per 100,000 person-years), and Black children exhibited an incidence of 9.1 per 100,000 person-years.

“In addition to identifying both all-scale and large-scale outages as risk factors for CO poisoning, our stratification into rural and urban regions of the state demonstrated that although the incident rate of CO poisoning is higher in rural regions of NYS, the associations between outages and CO ED visits were stronger in urban vs rural areas,” researchers reported.

Seasonal trends emerged, with most CO poisoning ED visits occurring in winter, according to the authors. Secondary analyses suggested increased vulnerability to CO poisoning during outages in both winter and spring.

Clinical & Public Health Interventions

In light of these findings, the authors recommended multilevel interventions to identify and prevent pediatric CO poisonings related to power outages.

“By ascertaining if patients recently lost power, clinicians may enhance their ability to diagnose CO poisoning despite its nonspecific symptomatology. Patient education, including safe use of generators and disaster plans during outages, could be discussed during well-child visits,” they advised. “Increased use of CO monitors may also be considered to identify harmful levels of indoor CO during outages.”

In addition, they recommended the use of targeted public‐awareness campaigns via television, social media, and text messaging, delivering real-time guidance to at‐risk populations during predicted outages.