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Pediatric Otolaryngology

(023) Airway Involvement of Severe Burns in Children

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Jordan Haber, BS

    Medical Student
    Ohio State University College of Medicine
    Maumee, Ohio, United States

    • Co-Author(s)

  • KL

    Kevin Liu, MD

    Clinical Research Fellow
    Department of Pediatric Otolaryngology, Nationwide Children's Hospital
    Columbus, Ohio, United States

  • Alessandra J. Bliss, Other

    Medical Student
    The Ohio State University
    Columbus, OH, USA

  • Prasanth Pattisapu, MD, MPH

    Assistant Professor
    Nationwide Childrens Hospital
    Columbus, Ohio, United States

  • TC

    Tendy Chiang, MD

    Assistant Professor
    Nationwide Children's Hospital
    Columbus, Ohio, USA

  • JG

    Jonathan M. Grischkan, MD, MS

    Assoc Prof of Otolaryngology- Head & Neck Surgery
    Nationwide Children's Hospital Department of Otolaryngology
    COLUMBUS, OH, United States

    • Senior Author(s)

  • ML

    Meredith N. Lind, MD

    Associate Professor of Otolaryngology
    1. Nationwide Children's Hospital Department of Otolaryngology 2. The Ohio State University College of Medicine
    Columbus, OH, United States

Disclosure(s):
Jordan Haber, BS: No relevant relationships to disclose.
Prasanth Pattisapu, MD, MPH: No relevant relationships to disclose.
Jonathan M. Grischkan, MD, MS: No relevant relationships to disclose.
Meredith N. Lind, MD: No relevant relationships to disclose.


Introduction: Children admitted to the pediatric intensive care unit (PICU) for severe burns commonly present with airway involvement, often necessitating bronchoscopy. The objectives of this study are to assess the incidence of airway pathology in pediatric burn patients and to identify risk factors for airway injury.

Methods: An IRB-approved retrospective single-institution cohort analysis of burn patients was conducted. Inclusion criteria included children under 18 years old admitted to the PICU for burns from 2015 to 2021 who underwent either operative or bedside bronchoscopy. Demographics, total body surface area (TBSA), respiratory distress, intubation in the field or during admission, and grade of airway injury were recorded. Chi-squared analysis was used to assess for factors associated with inhalational injury, while univariate linear regression was used to identify risk factors for inhalational injury.

Results: Inclusion criteria was met by 26 patients, majority white (n = 18, 69%) with a median age of 5 (IQR 3-12.6) years. Incidence of inhalational injury noted on bronchoscopy was 53.8% (14/26), most commonly grade 1 (n = 6, 23.1%) grade 2 (n = 5, 19.2%), and grade 3 (n = 3, 11.5%). Most patients exhibited symptoms of respiratory distress during PICU admission (n = 19, 73.1%), including respiratory failure (n = 6, 23.1%), stridor (n = 5, 19.2%), and aspiration (n = 2, 7.7%). Respiratory distress during burn admission was associated with airway injury on chi-squared analysis (p=0.026) and univariate logistic regression (RR 9.02, 95% CI 1.45-100.69). TBSA (p=1.000) and intubation (p=0.203) were not associated with airway injury. Most patients (23/26, 88.5%) had head and neck burns. On multivariate logistic regression, older age was not associated with presence of any airway injury (p=0.066) but was significantly associated with presence of grade 2 or worse airway injury (p=0.035).

Conclusions: Older age is associated with increased risk of severe inhalational injury, and respiratory distress during PICU admission is associated with inhalational injury on bronchoscopy.