David L. August MD, Presenter: Stockholder, General Electric Company

Kevin Foster MD,MBA, Abstract Co-Author: Nothing to Disclose

Karen Richey RN, Abstract Co-Author: Nothing to Disclose

Dan Gene Gridley MD, Abstract Co-Author: Nothing to Disclose

Michael Peck MD, Abstract Co-Author: Nothing to Disclose

Melissa Pressman PhD, Abstract Co-Author: Nothing to Disclose

Burn subjects with inhalation injury (II) demonstrate increased morbidity and mortality compared to burn subjects without II. The goal of this multicenter study is to develop a standardized scoring system for II that quantifies and predicts II severity in adults. This study looks at patients enrolled to date.

Data from burn patients with II enrolled in the ISIS study at one center were evaluated. II was diagnosed based on history, physical exam, lab data, and bronchoscopy findings. II severity was scored on a scale of 1-5 for carbon staining, edema, secretion, and erythema. Data included demographics, burn and II data, and outcome. Outcome data included mortality, ventilator days, ICU days, bronchoscopy score, and CT findings. Descriptive data was calculated and correlated to assess for presence and strength of associations among variables.

7 subjects were enrolled with II during the first 9 months of the study. Average age was 58 years, 86% male. Mechanism of injury for all subjects was flame/fire. Mean total body surface area burned was 20.3% (range 0-80%). Average ventilator time was 17 days, length of stay 21 days, with one subject still inpatient, and 1 death (14%). Average total bronchoscopy score was 7.9 (range 3-11). Average score for II severity was 3.3 (range 1-4) for carbon staining, 2 (range 0-3) for edema, 1.6 (range 1-2) for secretions, and 1 (range 0-2) for erythema. 43% of patients had pleural effusion, none with pneumothorax or tracheal/bronchial abnormalities present on CT. Average CT score/slice was 3.0 (range 0.8-5.1) and fraction of abnormal lung tissue (FALT) was 6.8% (range 0.1-18.6%). No bronchoscopies or CT were stopped early secondary to subject condition. There were statistically significant associations (p<0.10) between CT score and ventilator days (R=0.678); ICU length of stay (R=0.68) and total hospital days (R=0.623). Atelectasis, when present in these burn patients, was corrected for with prone positioning.

Preliminary data from ISIS demonstrated CT findings correlate positively with ventilator days in burn patients with II. This suggests that CT scanning may be helpful in predicting the severity of injury and likely clinical course in these patients.

CT scanning may help predict severity and hospital length of stay in the setting of inhalation injury.

August, D, Foster, K, Richey, K, Gridley, D, Peck, M, Pressman, M, Computerized Tomography Correlates with Ventilator Days in Inhalation Injury: Preliminary Data from the Inhalation Severity Injury Scoring System (ISIS) Trial.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015734.html