%0 Journal Article
%T Severity of inhalation injury and risk of nosocomial pneumonia: a retrospective cohort study.
%A Coston TD
%A Gaskins D
%A Bailey A
%A Minus E
%A Arbabi S
%A West TE
%A Stewart BT
%J Chest
%V 0
%N 0
%D 2024 Jul 2
%M 38964672
%F 10.262
%R 10.1016/j.chest.2024.06.3770
%X <B>BACKGROUND: </B>The impact of inhalation injury on risk of nosocomial pneumonia, an important complication in burn patients, is not well established.<BR><B>OBJECTIVE: </B>Is more severe inhalation injury associated with increased risk of nosocomial pneumonia?<BR><B>METHODS: </B>We performed a retrospective cohort study of patients with suspected inhalation injury admitted to a regional burn center from 2011 to 2022 who underwent diagnostic bronchoscopy within 48 hours of admission. We estimated the association of high-grade inhalation injury (abbreviated injury score [AIS] 3-4) versus low-grade inhalation injury (AIS 1-2) with nosocomial pneumonia (NP) adjusted for age, burn size, and comorbid obstructive lung disease. Death and hospital discharge were considered competing risks.<BR><B>RESULTS: </B>Of the 245 patients analyzed, 51 (21%) had high-grade injury, 180 (73%) had low-grade injury, and 14 (6%) had no inhalation injury. Among the 236 patients hospitalized for >48 hours, NP occurred in 24/50 (48%) patients in the high-grade group, 54/172 (31%) in the low-grade group, and 2/14 (14%) in the no inhalation injury group. High-grade (vs low-grade) inhalation injury was associated with higher hazard of NP in both the proportional cause-specific hazard model (CSHR 2.04; 95% CI, 1.26-3.30; p=0.004) and Fine-Gray subdistribution hazards model (SHR for NP, 2.24; 95% CI, 1.38-3.64; p=0.001).<BR><B>CONCLUSIONS: </B>Among patients with inhalation injury, more severe injury was associated with higher hazard of NP in competing risk analysis. Additional research is needed to investigate mechanisms that may explain the relationship between inhalation injury and NP and to identify more effective prevention strategies.