Inpatient and Postdischarge Outcomes Following Inhalation Injury Among Critically Injured Burn Patients

Abstract

Inhalation injury is associated with high inpatient mortality, but the impact of inhalation injury after discharge and on non-mortality outcomes are poorly characterized. To address this gap, we evaluated the effect of inhalation injury on post-discharge morbidity, mortality and hospital readmissions among patients who sustained burn injury, as well as on in-hospital outcomes for context.This was a retrospective cohort study of patients with cutaneous fire/flame burns admitted to a burn center intensive care unit from 1/1/2009-12/31/2015, with or without inhalation injury. Records were linked to statewide hospital admission and vital statistics databases to assess post-discharge outcomes. Mixed-effects Poisson regression was used to assess mortality, complications, and readmissions. The overall cohort included 830 patients with cutaneous burns; of these, 201 patients had inhalation injury. In-hospital mortality was 31% among inhalation injury patients versus 6% in patients without inhalation injury (adjusted OR 2.35; 95% CI 1.66-3.31). Inhalation injury was also associated with an increased risk of in-hospital pneumonia and tracheostomy (p<0.05 for all). Inhalation injury was not associated with greater post-discharge mortality, all-cause readmission, readmission for pulmonary diagnosis, or readmission requiring intubation. Among the subset of patients with bronchoscopy-confirmed inhalation injury (n=124; 62% of inhalation injuries), higher injury grade was not associated with greater inpatient or post-discharge mortality. Inhalation injury was associated with increased early morbidity and mortality, but did not contribute to post-discharge mortality or readmission. These findings have implications for shared decision-making with patients and families, and for estimating healthcare utilization after initial hospitalization.