Fiberoptic bronchoscopy for the early diagnosis of subglottal inhalation injury: comparative value in the assessment of prognosis.

The aim of this study was to determine the value of bronchoscopy in the early diagnosis of inhalation injury. A total of 130 burn patients underwent bronchoscopy on admission to a specialized center. In order to validate the method and the bronchoscopist's conclusions, they underwent staged bronchial biopsies. Using the histologic findings as the "gold standard," bronchoscopy proved to be sensitive (sensitivity, 0.79) and highly specific (specificity, 0.94) for the diagnosis of inhalation injury. In addition, it was more reliable than the circumstances of the injury, the clinical findings, and complementary tests. In a one-dimensional analysis, bronchoscopy-proven inhalation injury was one of the most strongly predictive variables for the onset of ARDS and death. The analysis of survival curves confirmed that inhalation injury portends a bad outcome in burn patients. It was used to predict the likelihood of ARDS and death at the time of admission with a view to early specific treatment.