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Inhalation Injury in Children: A 10 Year Experience at Shriners Hospitals for Children

Palmieri, Tina L. MD, FACS, FCCM*†; Warner, Petra MD‡§; Mlcak, Ronald P. MD∥¶; Sheridan, Robert MD#**; Kagan, Richard J. MD‡§; Herndon, David N. MD∥¶; Tompkins, Ronald MD#**; Greenhalgh, David G. MD*†

doi: 10.1097/BCR.0b013e3181923ea4
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Inhalation injury remains a significant source of morbidity and mortality in children with burn injury. The purpose of this study is to analyze the incidence, demographic characteristics, and outcomes for children who have sustained burn injury at one of four regional pediatric burn centers. A retrospective review of children aged 0 to 18 years admitted to one of four pediatric burn centers from 1997 to 2007 with a diagnosis of inhalation injury was performed. Factors analyzed included demographics, injury severity, treatment duration, and outcomes. A total of 850 patients with a mean age of 7.9 ± 0.2 years and a mean total body surface area burn of 48.6 ± 0.9% were admitted with a diagnosis of inhalation injury. Mean interval between injury and hospital admission was 4.2 ± 0.3 days. Inhalation injury was diagnosed by bronchoscopy in 71%, via elevated carboxyhemoglobin in 4%, and by clinical signs/history alone in 25%. Hospital length of stay averaged 44.8 ± 1.7 days, and patients required mechanical ventilation for a mean of 15.2 ± 0.8 days. Mortality was 16.4%. Inhalation injury in children is associated with significant morbidity and mortality, and diagnosis of inhalation injury does not follow consistent guidelines. Further studies are required to standardize diagnostic criteria for inhalation injury and to optimize the treatment of children with inhalation injury.

From the *Department of Burn Surgery, Shriners Hospitals for Children, Northern California; †Department of Surgery, The University of California Davis, Sacramento; ‡Department of Burn Surgery, Shriners Hospital for Children, Cincinnati, Ohio; §Department of Surgery, University of Cincinnati, Ohio; ∥Department of Burn Surgery, Shriners Hospital for Children, Galveston, Texas; ¶Department of Surgery, University of Texas Medical Branch, Galveston; #Department of Burn Surgery, Shriners Hospital for Children, Boston, Massachusetts; and **Massachusetts General Hospital, Boston.

This study was supported by a Grant 8431 from Shriners Hospitals for Children.

Address correspondence to Tina L. Palmieri, MD, 2425 Stockton Boulevard, Suite 718, Sacramento, California 95817.

© 2009 The American Burn Association