Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity

• Published in: Burns Vol. 40; no. 7; pp. 1308 - 1315
• Main Authors: Kwon, Herbert P, Zanders, Thomas B, Regn, Dara D, Burkett, Samuel E, Ward, John A, Nguyen, Ruth, Necsoiu, Corina, Jordan, Bryan S, York, Gerald E, Jimenez, Santiago, Chung, Kevin K, Cancio, Leopoldo C, Morris, Michael J, Batchinsky, Andriy I
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.11.2014
• Subjects: Animals; Bronchoscopy; Computed tomography scan; Critical Care; Female; Fiber-optic bronchoscopy; Inhalation injury; Lung - diagnostic imaging; Sensitivity and Specificity; Severity of Illness Index; Smoke Inhalation Injury - diagnosis; Smoke Inhalation Injury - diagnostic imaging; Swine; Tomography, X-Ray Computed; Virtual bronchoscopy; Inhalation injury; Virtual bronchoscopy; Computed tomography scan; Fiber-optic bronchoscopy; Swine
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2014.06.007

Abstract Purpose Compare virtual bronchoscopy (VB) to fiberoptic bronchoscopy (FOB) for scoring smoke inhalation injury (SII). Methods Swine underwent computerized tomography (CT) with VB and FOB before (0) and 24 and 48 h after SII. VB and FOB images were scored by 5 providers off line. Results FOB and VB scores increased over time ( p < 0.001) with FOB scoring higher than VB at 0 (0.30 ± 0.79 vs. 0.03 ± 0.17), 24 h (4.21 ± 1.68 vs. 2.47 ± 1.50), and 48 h (4.55 ± 1.83 vs. 1.94 ± 1.29). FOB and VB showed association with PaO2 -to-FiO2 ratios (PFR) with areas under receiver operating characteristic curves (ROC): for PFR ≤ 300, VB 0.830, FOB 0.863; for PFR ≤ 200, VB 0.794, FOB 0.825; for PFR ≤ 100, VB 0.747, FOB 0.777 (all p < 0.001). FOB showed 80.3% specificity, 77% sensitivity, 88.8% negative-predictive value (NPV), and 62.3% positive-predictive value (PPV) for PFR ≤ 300 and VB showed 67.2% specificity, 85.5% sensitivity, 91.3% NPV, and 53.4% PPV. Conclusions VB provided similar injury severity scores to FOB, correlated with PFR, and reliably detected airway narrowing. VB performed during admission CT may be a useful screening tool specifically to demonstrate airway narrowing induced by SII.