865 12 Year Experience of Inhalation Injuries from House and Structure Fires

TL;DR

This study analyzes 12 years of inhalation injury data to identify factors affecting outcomes in patients from house and structure fires.

Contribution

The study provides insights into clinical patterns and risk factors for inhalation injuries, emphasizing the role of bronchoscopy in prognosis.

Findings

Moderate and severe inhalation injuries correlate with longer hospital stays and ventilator use.

Carbon monoxide poisoning is common but not a strong predictor of hospital outcomes.

Bronchoscopy findings are significant in predicting clinical outcomes.

Abstract

Inhalation injuries from house and structure fires can pose significant risks, including infection, inflammation, and multi-organ dysfunction. Because inhalation injuries are an understudied aspect of acute burn care, the aim of this study was to identify and analyze salient factors affecting clinical outcomes for this vulnerable patient population.

We performed a 12-year retrospective study (January 2012 to January 2024) of house-fire patients treated at an ABA-certified burn center. Flash burns from smoking on home oxygen therapy were excluded as they do not maintain the characteristics of true inhalation injuries. The severity of inhalation injury was assessed using the Abbreviated Injury Score (AIS) following fiberoptic bronchoscopy. Data involving complications, ventilator days, and length of stay were collected.

Of 462 patients in house or structure fires, 222 (48%) underwent diagnostic bronchoscopy. 184 of these had findings consistent with inhalation injury (75 mild, 79 moderate, and 30 severe). The cohort’s average age was 54 ± 19 years, with a male-to-female ratio of 1.3. Most injuries occurred in November through January. 31.5% patients (n=58) were intubated at the scene, and 64.7% (n=119) upon hospital arrival. 33.2% (n=61) initially presented at an outside hospital before being transferred to our burn unit. The median TBSA of cutaneous burns was 1% (IQR: 0-14), and median carboxyhemoglobin was 11.8 (IQR: 5.9-26.8). 50 patients (27.2%) underwent excision and grafting, with a median time to graft of 5 days (IQR: 3-6). The median ventilator time was 3 days (IQR: 1–9.5), and the median hospital stay was 10.5 days (IQR: 3.5–21). Pneumonia was the most common complication (41.3%). 26 patients (14.1%) developed ARDS, and there were 34 deaths within one month (18.5%). After adjusting for age, BMI, TBSA, and carbon monoxide poisoning, patients with moderate or severe injuries were hospitalized for an additional 6.8 days (p = 0.008) and 5.7 days (p = 0.066), respectively, compared to those with mild injuries. Moderate and severe injuries also resulted in 3.4 days (p = 0.048) and 4.6 days (p = 0.044) longer on a ventilator than mild injuries.

Most patients suffering inhalation injuries have carbon monoxide poisoning and minimal cutaneous burns. While carbon monoxide poisoning was not an accurate predictor of ventilator days nor hospital length of stay, the extent of visible airway injury seen on bronchoscopy correlated significantly with these outcomes. These findings underscore the importance of thorough and accurate use of bronchoscopy evaluations in the acute period for prognostication and management planning.

Studying hospital outcomes for inhalation injuries enhances prognostication, multidisciplinary care, and the identification of at-risk populations. This research also helps recognize clinical patterns and risk factors associated with poorer outcomes.

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