Admission Chest CT Complements Fiberoptic Bronchoscopy in Prediction of Adverse Outcomes in Thermally Injured Patients

Abstract

In burned patients, inhalation injury can result in progressive pulmonary dysfunction, infection, and death. Although bronchoscopy is the standard for diagnosis, it only assesses the proximal airway and does not provide a comprehensive analysis of pulmonary insult. Chest radiographs have not been proven helpful in diagnosis of inhalation injury. Our hypothesis is that a CT scan alone or in conjunction with bronchoscopy can be used as a prognostic tool for critically ill burn patients, especially those with inhalation injury. The authors performed a retrospective study of all patients admitted to the U.S. Army Institute of Surgical Research Burn Center between 2002 and 2008 with chest CT within 24 hours of admission. They divided subjects into two groups, those with evidence of inhalation injury on bronchoscopy and those without. They used a radiologist s score to assess the degree of damage to the pulmonary parenchyma. The primary endpoint was a composite of pneumonia, acute lung injury/acute respiratory distress syndrome, and death. The inhalation injury group consisted of 25 patients and the noninhalation injury group of 19 patients. Groups were not different in age, TBSA burned, and percentage full-thickness burn. By multiple logistic regression, detection of inhalation injury on bronchoscopy was associated with an 8.3-fold increase in the composite endpoint. The combination of inhalation injury on bronchoscopy and a high radiologist s score was associated with a 12.7-fold increase in the incidence of the composite endpoint. Admission CT assists in predicting future lung dysfunction in burn patients.

Open PDF

Document Details

Document Type
Technical Report
Publication Date
Aug 01, 2012
Accession Number
ADA616964

Entities

People

  • Andriy I Batchinsky
  • Anthony Allen
  • Booker T. King
  • John S. Oh
  • Kevin K Chung
  • Leopoldo C. Cancio
  • Steven Wolf
  • Todd Huzar
  • Tyson Sjulin

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Acute Respiratory Distress Syndrome
  • Bronchoscopy
  • Burns
  • Health Services
  • Lung Diseases
  • Medical Personnel
  • Regression Analysis
  • Risk Factors
  • Statistical Analysis
  • Wounds And Injuries
  • X-Ray Computed Tomography

Fields of Study

  • Medicine

Readers

  • Immunology and Pathology
  • Medical Imaging.
  • Trauma or Military Medicine