Characteristics and outcomes of patients with inhalation injury treated at a military burn center during U.S. combat operations.

BACKGROUND

The purpose of this study was to examine risk factors for mortality in burned patients with inhalation injury (II). We further sought to compare a cohort of burned military service members to civilian patients with II.

METHODS

We identified patients treated at our burn center over a 10-year period. Demographics, injury characteristics, and outcomes were compared between patients with and without II. Logistic regression analysis was performed to determine the impact of patient characteristics and II grade on mortality.

RESULTS

3791 patients treated at our burn center met study inclusion criteria. 424 (11.2%) patients were diagnosed with II [II(+)]. Age, % total body surface area (TBSA) burned, % full thickness burned, intensive care unit (ICU) days, hospital days, and mortality were all greater in II(+) patients. Separating the II(+) patients into military and civilian groups, there was a higher incidence of grade 4 II and higher mortality for grades 2-4 II in military patients. Analyses demonstrated that military service was associated with increased mortality in II(+) patients. The bronchoscopic grade of II did not have an association with mortality in this population.

CONCLUSIONS

II(+) patients were older, had larger burns, needed more ICU and hospital days, and had higher mortality rates. Among II(+) patients, military affiliation was associated with more severe II and increased mortality. Establishment of an objective grading system for II that is associated with mortality is a meaningful future research endeavor.