title: Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity.
abstract: OBJECTIVE
  Compare virtual bronchoscopy (VB) to fiberoptic bronchoscopy (FOB) for scoring smoke inhalation injury (SII).
  
  
  METHODS
  Swine underwent computerized tomography (CT) with VB and FOB before (0) and 24 and 48 h after SII. VB and FOB images were scored by 5 providers off line.
  
  
  RESULTS
  FOB and VB scores increased over time (p<0.001) with FOB scoring higher than VB at 0 (0.30±0.79 vs. 0.03±0.17), 24 h (4.21±1.68 vs. 2.47±1.50), and 48h (4.55±1.83 vs. 1.94±1.29). FOB and VB showed association with PaO2-to-FiO2 ratios (PFR) with areas under receiver operating characteristic curves (ROC): for PFR≤300, VB 0.830, FOB 0.863; for PFR≤200, VB 0.794, FOB 0.825; for PFR≤100, VB 0.747, FOB 0.777 (all p<0.001). FOB showed 80.3% specificity, 77% sensitivity, 88.8% negative-predictive value (NPV), and 62.3% positive-predictive value (PPV) for PFR≤300 and VB showed 67.2% specificity, 85.5% sensitivity, 91.3% NPV, and 53.4% PPV.
  
  
  CONCLUSIONS
  VB provided similar injury severity scores to FOB, correlated with PFR, and reliably detected airway narrowing. VB performed during admission CT may be a useful screening tool specifically to demonstrate airway narrowing induced by SII.
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
authors.forename: Herbert P
authors.initials: HP
authors.lastname: Kwon
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Zanders
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
authors.forename: Dara D
authors.initials: DD
authors.lastname: Regn
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Burkett
authors.affiliation: Department of Clinical Investigation, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, United States.
authors.forename: John A
authors.initials: JA
authors.lastname: Ward
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
authors.forename: Ruth
authors.initials: R
authors.lastname: Nguyen
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
authors.forename: Corina
authors.initials: C
authors.lastname: Necsoiu
authors.affiliation: U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Jordan
authors.affiliation: Department of Radiology, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, United States.
authors.forename: Gerald E
authors.initials: GE
authors.lastname: York
authors.affiliation: Department of Radiology, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, United States.
authors.forename: Santiago
authors.initials: S
authors.lastname: Jimenez
authors.affiliation: U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
authors.affiliation: U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States.
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Morris
authors.affiliation: U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States. Electronic address: andriy.i.batchinsky.vol@mail.mil.
authors.forename: Andriy I
authors.initials: AI
authors.lastname: Batchinsky
mesh_terms: D000818:Animals; D001999:Bronchoscopy; D005260:Female; D008168:Lung / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015208:Smoke Inhalation Injury / Q000175:diagnosis* / Q000000981:diagnostic imaging; D013552:Swine; D014057:Tomography, X-Ray Computed
keywords: Computed tomography scan; Fiber-optic bronchoscopy; Inhalation injury; Swine; Virtual bronchoscopy