• 
• 

Three Part Question

In [adult burns patients] what [clinical features] are suggestive of [significant inhalational injury]?

Clinical Scenario

A 45 year-old male has been trapped in a house fire. You are concerned that he may have an inhalational injury. You wonder which clinical features suggest significant inhalational injury.

Search Strategy

Medline using the OVID interface 1966-06/05
[exp BURNS, INHALATION/ or exp BURNS/ or burn$.mp. or thermal injury.mp] AND [exp Smoke Inhalation Injury/ or exp Burns/ or exp Burns, Inhalation/ or inhalation injury.mp.] AND
[clinical feature.mp.or signs and symptoms.mp. or
clinical feature$ or soot.mp. or singed nasal hair$.mp. or stridor.mp.] LIMIT to humans AND english language.
EMBASE 1980-06/05
[burns.mp. or exp Burn/ or thermal burns.mp.] AND [exp Burn/ or exp Inhalation/ or exp Injury] AND [clinical feature$ or Clinical feature/ or signs and symptoms.mp] LIMIT to Human and English Language.

Search Outcome

146 papers were found in medline of which none were relevant. No relevant papers were found out of the 681 produced by the Embase search.

Comment(s)

No relevant papers were found to answer this question. However, reviews have mentioned that facial burns, carbonaceous sputum, nasal or oral soot, wheezing, hoarseness and singed nasal hairs are all signs and symptoms of inhalation injury. Bronchoscopy is the gold standard for diagnosing inhalation injury but as of yet no research has been undertaken to compare this gold standard with clinical features when diagnosing inhalation injury.

Clinical Bottom Line

There is no evidence available addressing the issues of clinical features suggesting inhalation injury in adult burns patients. Consensus opinion should be followed.