Si Jack CHONG1, Yee Onn KOK1, Rosanna TAY2, Kok Chai TAN1
1 Singapore General Hospital, Plastic , Reconstructive and Aesthetic Surgery
2 National University of Singapore, Yong Loo Lin School of Medicine
Inhalation injury is a major cause of morbidity and mortality in burns patients[i]
This study aims to analyze the incidence rate, clinical outcomes and bacteriology of inhalational burns patient.
A prospective study was done on inhalational burns patients (n=35/202) admitted to a major burns centre over 15 months from January 2015 – March 2016. Diagnosis of inhalational injury was based on history, symptoms and prior diagnosis in referred patients. Data was analyzed using SPSS statistical software, Chi-square analyses on categorical variables and Mann Whitney U test for non-parametric continuous variables.
The average age and total burnt surface area was 43y and 12.1%. Patients with inhalation injury had more surgeries (3 vs 1 p=0.003), increased length of stay (21 days vs 8 days, p=0.004) and in-hospital mortality rate (17.1 % vs 0.6% p=0.000).
Incidence of AKI and ARDS was 48.6% and 37.1% compared to 0.6% and 1.2% in the patients without inhalational injury (p=0.000). Patients with inhalational injury had increased incidence of bacteraemia (31.4% vs 2.4 %, p= 0.000), pneumonia (37.1% vs 1.2%, p=0.000) and burn wound infection (51.4% vs 25.1%, p=0.004). Acinetobacter baumannii was the most frequently cultured bacteria in sputum, blood and tissue cultures with inhalational injury. Gram-negative bacteria were predominantly cultured from tissue in patients with inhalational injury.
The data confirms and quantitates that inhalation injury accompanying thermal trauma significantly increases the length of stay, mortality and occurrence of complications.
Burns, Inhalational Burns, Length of Stay, TBSA, ARDS
Dr Chong is a Consultant at Singapore General Hospital, home to the national and regional major burns referral centre. He is also the Medical Director of the Tissue Bank and Burns Centre. He has a keen interest in burns and improving its outcome.