title: The impact of inhalation injury in patients with small and moderate burns.
abstract: BACKGROUND
  Inhalation injury is an independent risk factor of mortality in burn patients. The burn index (BI), which includes burn depth and size, also plays a role in predicting mortality. We aimed to establish a relationship between survival rate, inhalation injury, and BI.
  
  
  METHODS
  From 1997 to 2010, 21,791 burn patients from 44 hospitals were retrospectively reviewed. Kaplan-Meier and log-rank assessments were used for survival curve analysis. Chi-square, Fishers-exact test and odds ratio evaluations were used to assess the relationship between mortality rate, inhalation injury, BI. Two population proportion Z test was used to analyze the causes of death and morbidity. The significance level was set at 0.01.
  
  
  RESULTS
  The overall mortality rate was 2.1%. Inhalation injuries were found in 7.9% of the patients. The mortality rate of inhalation and non-inhalation injury group was 17.9% and 0.7%, respectively. The survival rate of the inhalation injury group was significantly lower than that of the non-inhalation injury group at BI 0-50. The patients with both inhalation injury and BI less than 50 had significant higher rate to die of pneumonia, respiratory failure, sepsis and wound infection. There was no significant difference when BI was larger than 50.
  
  
  CONCLUSIONS
  Inhalation injuries significantly reduced the survival rate, especially when the BI was less than 50. The possibility of pulmonary dysfunction and complications arising from inhalation injury should be considered even in patients who have small cutaneous burns associated with inhalation injuries.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan.
authors.forename: Mei-Chun
authors.initials: MC
authors.lastname: Chen
authors.affiliation: Department of Statistics, Tamkang University, New Taipei City, Taiwan.
authors.forename: Man-Hua
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Statistics, Tamkang University, New Taipei City, Taiwan.
authors.forename: Bor-Shyh
authors.initials: BS
authors.lastname: Wen
authors.affiliation: Department of Statistics, Tamkang University, New Taipei City, Taiwan.
authors.forename: Ming-Hsuan
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan. Electronic address: sma@vghtpe.gov.tw.
authors.forename: Hsu
authors.initials: H
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000401:mortality* / Q000473:pathology; D002059:Burns, Inhalation / Q000150:complications / Q000401:mortality*; D002648:Child; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000401:mortality*; D012867:Skin / Q000473:pathology; D015599:Trauma Severity Indices; D014946:Wound Infection / Q000150:complications / Q000401:mortality*; D055815:Young Adult
keywords: Burn index; Inhalation injury; Survival rate