Introduction:
Burn inhalation injury is a significant contributor to morbidity and mortality in burn patients. Despite a wealth of evidence and international guidelines on this topic, aspects of burn inhalation injury remain elusive [1]. Further research is limited by the lack of accepted diagnostic criteria [2] and inconsistent language describing airway findings following burn inhalation injury.
Purpose:
The aims of this study were to
1) Develop a novel scoring system to standardise description of airway changes in burn inhalation injury and stratify by severity of injury
2) Assess the utility of this novel scoring system in prognosticating burn patient outcomes following burn inhalation injury
Methods:
A retrospective study of consecutive patients with burn inhalation injury was conducted at Royal Adelaide Hospital over a three year period. A scoring system for airway assessment reported by co-authors at the Fiona Stanley Hospital, Perth (publication pending), the SInhale Classification System, was prospectively developed and retrospectively applied to this burn patient cohort.
Results/Discussion:
Class III injury was found to be significantly associated with greater than 24h of intubation, increased mean duration of mechanical ventilation and increased mean Intensive Care and inpatient lengths of stays, compared with Class I injury (mild upper airway SII). Class II injury (severe upper airway SII) was significantly associated with failure of extubation. Full thickness head and neck burn and soot in the oral cavity/oropharynx/nasopharynx were the only statistically significant clinical variables correlated with severe (Class II and III) injuries.
Conclusion:
SInhale appears to be a useful tool for the standardisation of airway assessment in burn inhalation injury. External and prospective multi-centre studies are underway in Australia and New Zealand as part of a burn inhalation injury special interest group established to further validate these findings.