A novel scale for predicting delayed intubation in patients with inhalation injury

Kazuki Matsumura; Ryo Yamamoto; Tomohiro Kamagata; Tomohiro Kurihara; Kazuhiko Sekine; Kiyotsugu Takuma; Kenichi Kase; Junichi Sasaki

doi:10.1016/j.burns.2019.12.017

A novel scale for predicting delayed intubation in patients with inhalation injury

Burns. 2020 Aug;46(5):1201-1207. doi: 10.1016/j.burns.2019.12.017. Epub 2020 Jan 22.

Authors

Kazuki Matsumura¹, Ryo Yamamoto², Tomohiro Kamagata³, Tomohiro Kurihara¹, Kazuhiko Sekine³, Kiyotsugu Takuma⁴, Kenichi Kase⁵, Junichi Sasaki¹

Affiliations

¹ Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
² Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. Electronic address: ryo.yamamoto@gmail.com.
³ Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minatoku, Tokyo, 108-0073, Japan.
⁴ Department of Emergency Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasakiku, Kanagawa, 210-0013, Japan.
⁵ Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, 321-9574, Japan.

PMID: 31982185
DOI: 10.1016/j.burns.2019.12.017

Abstract

Background: Strategies to predict delayed airway obstruction in patients with inhalation injury have not been extensively studied. This study aimed to develop a novel scale, predicting the need for Delayed Intubation after inhalation injury (PDI) score.

Methods: We retrospectively identified patients with inhalation injury at four tertiary care centers in Japan between 2012 and 2018. We included patients aged 15 or older and excluded those intubated within 30 min after hospital arrival. Predictors for delayed intubation were identified with univariate analyses and scored on the basis of odds ratios. The PDI score was evaluated with the area under the receiver operating characteristic (AUROC) curve and compared with other scaling systems for burn injuries.

Results: Data from 158 patients were analyzed; of these patients, 18 (11.4%) were intubated during the delayed phase. Signs of respiratory distress, facial burn, and pharyngolaryngeal swelling observed on laryngoscopy, were identified as predictors for delayed intubation. The discriminatory power of the PDI (AUROC curve = 0.90; 95% confidence interval, 0.83 to 0.97; p < 0.01) was higher than that of the other scaling systems.

Conclusions: We developed a novel scale for predicting delayed intubation in inhalation injury. The score should be further validated with other population.

Keywords: Burns; Delayed intubation; Delayed upper airway obstruction; Inhalation injury; Prediction; Scoring.

Publication types

Observational Study

MeSH terms

Adult
Age Factors
Aged
Airway Obstruction / epidemiology*
Airway Obstruction / etiology
Airway Obstruction / therapy
Area Under Curve
Edema / epidemiology
Facial Injuries / epidemiology*
Female
Humans
Intubation, Intratracheal / statistics & numerical data*
Laryngeal Edema / epidemiology*
Laryngoscopy
Male
Middle Aged
Odds Ratio
Pharyngeal Diseases / epidemiology
ROC Curve
Respiratory Insufficiency / epidemiology*
Respiratory Insufficiency / therapy
Retrospective Studies
Risk Assessment
Smoke Inhalation Injury / complications
Smoke Inhalation Injury / therapy*
Time Factors