title: Pulmonary histopathologic abnormalities and predictor variables in autopsies of burned pediatric patients.
abstract: Pulmonary abnormalities occur in 30-80% of fatalities after burn. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients.
  
  
  METHODS
  Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002 to 2012 (n=43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models.
  
  
  RESULTS
  Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p<0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p<0.01). The scores for protein were significantly higher in cases with longer survival after burn (p<0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p<0.01), and in cases with the presence of inhalation injury (p<0.01).
  
  
  CONCLUSIONS
  Histological findings associated with diffuse alveolar damage (DAD), which is the pathological correlate of the acute respiratory distress syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury.
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Sousse
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: Clark R
authors.initials: CR
authors.lastname: Andersen
authors.affiliation: Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Zovath
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: Celeste C
authors.initials: CC
authors.lastname: Finnerty
authors.affiliation: Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Mlcak
authors.affiliation: Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA; Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cox
authors.affiliation: Anesthesiology, University of Texas Medical Branch, Galveston, TX 77555, USA; Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Traber
authors.affiliation: Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA; Shriners Hospitals for Children, Burn Unit, Galveston, TX 77555, USA. Electronic address: hhawkins@utmb.edu.
authors.forename: Hal K
authors.initials: HK
authors.lastname: Hawkins
mesh_terms: D055371:Acute Lung Injury / Q000150:complications / Q000473:pathology*; D000293:Adolescent; D001344:Autopsy; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000473:pathology; D006470:Hemorrhage / Q000150:complications / Q000473:pathology; D006801:Humans; D006818:Hyalin; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology*; D008297:Male; D011654:Pulmonary Edema / Q000150:complications / Q000473:pathology; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000473:pathology*; D012189:Retrospective Studies; D015208:Smoke Inhalation Injury / Q000150:complications / Q000473:pathology*; D013997:Time Factors
keywords: Adult respiratory distress syndrome; Diffuse alveolar damage; Histology; Pediatric patients; Predictor variables; Scoring; Survivability