Department of Surgery, University of Colorado Denver, USA.
Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA.
J Burn Care Res. 2021 Nov 24;42(6):1168-1175. doi: 10.1093/jbcr/irab029.
Inhalation injury is associated with high inpatient mortality, but the impact of inhalation injury after discharge and on non-mortality outcomes is poorly characterized. To address this gap, we evaluated the effect of inhalation injury on postdischarge morbidity, mortality, and hospital readmissions among patients who sustained burn injury, as well as on in-hospital outcomes for context. This was a retrospective cohort study of patients with cutaneous fire/flame burns admitted to a burn center intensive care unit from January 1, 2009 to December 31, 2015, with or without inhalation injury. Records were linked to statewide hospital admission and vital statistics databases to assess postdischarge outcomes. Mixed-effects Poisson regression was used to assess mortality, complications, and readmissions. The overall cohort included 830 patients with cutaneous burns; of these, 201 patients had inhalation injury. In-hospital mortality was 31% among inhalation injury patients vs 6% in patients without inhalation injury (adjusted OR 2.35; 95% CI 1.66-3.31). Inhalation injury was also associated with an increased risk of in-hospital pneumonia and tracheostomy (P < .05 for all). Inhalation injury was not associated with greater postdischarge mortality, all-cause readmission, readmission for pulmonary diagnosis, or readmission requiring intubation. Among the subset of patients with bronchoscopy-confirmed inhalation injury (n = 124; 62% of inhalation injuries), a higher injury grade was not associated with greater inpatient or postdischarge mortality. Inhalation injury was associated with increased early morbidity and mortality, but did not contribute to postdischarge mortality or readmission. These findings have implications for shared decision making with patients and families and for estimating healthcare utilization after initial hospitalization.
吸入性损伤与住院患者死亡率高有关，但吸入性损伤对出院后和非死亡率结局的影响特征描述不足。为了弥补这一空白，我们评估了吸入性损伤对烧伤患者出院后发病率、死亡率和再入院率的影响，以及对住院期间结局的影响。这是一项回顾性队列研究，纳入了 2009 年 1 月 1 日至 2015 年 12 月 31 日期间因皮肤火/火焰烧伤入住烧伤中心重症监护病房的患者，无论是否存在吸入性损伤。记录与全州住院和生命统计数据库相关联，以评估出院后结局。混合效应泊松回归用于评估死亡率、并发症和再入院率。总队列包括 830 例皮肤烧伤患者；其中 201 例有吸入性损伤。吸入性损伤患者的院内死亡率为 31%，无吸入性损伤患者的死亡率为 6%（校正比值比 2.35；95%CI 1.66-3.31）。吸入性损伤还与院内肺炎和气管切开的风险增加相关（所有 P<0.05）。吸入性损伤与出院后死亡率、所有原因再入院、因肺部诊断再入院或需要插管的再入院均无相关性。在接受支气管镜检查确诊的吸入性损伤患者亚组（n=124；吸入性损伤的 62%）中，更高的损伤程度与住院期间或出院后死亡率的增加无关。吸入性损伤与早期发病率和死亡率增加相关，但与出院后死亡率或再入院率无关。这些发现对与患者及其家属进行共同决策以及估计初始住院后的医疗保健利用具有影响。
