title: Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria.
abstract: BACKGROUND
  Inhalation injury is an important determinant of outcome in patients with major burns. However the diagnostic criteria remain imprecise, preventing objective comparisons of published data. The aims were to evaluate the utility of an inhalation score based on mucosal injury, while assessing separately the oro-pharyngeal sphere (ENT) and tracheobronchial tree (TB) in patients admitted to the ICU with a suspicion of inhalation injury.
  
  
  METHODS
  Prospective observational study in 100 patients admitted with suspicion of inhalation injury among 168 consecutive burn admissions to the ICU of a university hospital. Inclusion criteria, endoscopic airway assessment during the first hours. ENT/TB lesion grading was 1: oedema, hyperemia, hypersecretion, 2: bullous mucosal detachment, erosion, exudates, 3: profound ulcers, necrosis.
  
  
  RESULTS
  Of the 100 patients (age 42±17 years, burns 23±19%BSA), 79 presented an ENT inhalation injury ≥ENT1 (soot present in 24%): 36 had a tracheobronchial extension, 33 having a grade ≥TB1. Burned vibrissae: 10 patients "without" suffered ENT injury, while 6 patients "with" had no further lesions. Length of mechanical ventilation was strongly associated with the first 24 hrs' fluid resuscitation volume (p<0.0001) and the presence of inhalation injury (p=0.03), while the ICU length of stay was correlated with the %BSA. Soot was associated with prolonged mechanical ventilation (p=0.0115). There was no extubation failure.
  
  
  CONCLUSIONS
  The developed inhalation score was simple to use, providing a unified language, and drawing attention to upper airway involvement. Burned vibrissae and suspected history proved to be insufficient diagnostic criteria. Further studies are required to validate the score in a larger population.
authors.affiliation: Service of Head and Neck Surgery (ENT), University Hospital (CHUV), Lausanne, Switzerland. Christos.Ikonomidis@chuv.ch
authors.forename: Christos
authors.initials: C
authors.lastname: Ikonomidis
authors.forename: Florian
authors.initials: F
authors.lastname: Lang
authors.forename: Alexandre
authors.initials: A
authors.lastname: Radu
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
mesh_terms: D000328:Adult; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020545:Respiratory Mucosa / Q000293:injuries* / Q000473:pathology; D015208:Smoke Inhalation Injury / Q000175:diagnosis* / Q000473:pathology