Repeat Bronchoscopies Are Poorly Predictive of Outcomes Following Inhalation Injury

Inhalation injury is an independent predictor of mortality after burn injury. Although bronchoscopy remains the gold standard for diagnosing inhalation injury, there is a paucity of evidence to support repeat bronchoscopies for following inhalation injuries during a patient's clinical course. This study looks at the ability of serial bronchoscopies to prognosticate outcomes. This was a secondary analysis of a previously reported prospective observational study. Patients diagnosed with inhalation injury had repeat bronchoscopies with blinded investigators assigning severity scores. The study used multivariate regression analysis to investigate whether inhalation injury severity scores of the carinal images were predictive of mortality. Secondary outcomes included diagnosis of acute respiratory distress syndrome or pneumonia during hospitalization. The final analysis included 99 patients. After accounting for age, percent TBSA burn, and injury severity scores, there were no days that were significant for predicting outcomes. All days were poor predictors overall, with the area under the receiver operating curve being <0.8 in all instances. These results do not support the use of serial bronchoscopies for prognostication purposes. Until a larger, randomized clinical trial can evaluate this further, serial bronchoscopies performed for assessment of the progression of inhalation injury may provide more risk than benefit.