Assessment of severity of ovine smoke inhalation injury by analysis of computed tomographic scans

Myung (Michelle) S Park, Leopoldo C. Cancio, Andriy I. Batchinsky, Michael J. McCarthy, Bryan S. Jordan, William W. Brinkley, Michael A. Dubick, Cleon W. Goodwin, Nicholas Namias, Jay A. Yelon, Henry J. Schiller, Gregory A. Timberlake

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46 Scopus citations

Abstract

Background: Our goal was to evaluate computed tomographic (CT) scans of the chest as a means of stratifying smoke inhalation injury (SII) severity. Methods: Twenty anesthetized sheep underwent graded SII: group I, no smoke; group II, 5 smoke units; group III, 10 units; and group IV, 16 units. CT scans were obtained at 6, 12, and 24 hours after injury. Each quadrant of each slice was scored subjectively: 0 = normal, 1 = interstitial markings, 2 = ground-glass appearance, and 3 = consolidation. The sum of all scores was the radiologist's score (RADS) for that scan. Computerized analysis of three-dimensional reconstructed scans was also performed, based on Hounsfield unit ranges: hyperinflated, -1,000 to -900; normal, -899 to -500; poorly aerated, -499 to -100; and nonaerated, -99 to +100. The fraction of abnormal lung tissue (FALT) was computed from poorly aerated, nonaerated, and total volumes. Mean gray-scale density (DENS) was also computed. Results: SII resulted in severity- and time-related changes in oxygenation (alveolar-arterial gradient), ventilation (respiratory rate-pressure product), DENS, FALT, and RADS. Ordinal logistic regression generated a predictive model for severity of injury (r2 = 0.623, p = 0.001), retaining RADS at 24 hours and rejecting the other variables. Conclusion: At 24 hours, CT scanning enabled SII severity stratification; qualitative evaluation (RADS) outperformed current semiautomated methods (DENS, FALT).

Original languageEnglish (US)
Pages (from-to)417-429
Number of pages13
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume55
Issue number3
DOIs
StatePublished - Sep 1 2003
Externally publishedYes

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Keywords

  • Adult respiratory distress syndrome
  • Computed tomography
  • Lung
  • Radiograph
  • Sheep
  • Smoke inhalation injury

ASJC Scopus subject areas

  • Surgery

Cite this

Park, M. M. S., Cancio, L. C., Batchinsky, A. I., McCarthy, M. J., Jordan, B. S., Brinkley, W. W., Dubick, M. A., Goodwin, C. W., Namias, N., Yelon, J. A., Schiller, H. J., & Timberlake, G. A. (2003). Assessment of severity of ovine smoke inhalation injury by analysis of computed tomographic scans. Journal of Trauma - Injury, Infection and Critical Care, 55(3), 417-429. https://doi.org/10.1097/01.TA.0000083609.24440.7F