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

Myung S. Park, Leopoldo C. Cancio, Andriy I. Batchinsky, Michael J. McCarthy, Bryan S. Jordan, Michael A. Dubick, Cleon W. Goodwin

Research output: Contribution to journalArticle

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
Volume55
Issue number3
DOIs
StatePublished - Sep 2003

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Park, M. S., Cancio, L. C., Batchinsky, A. I., McCarthy, M. J., Jordan, B. S., Dubick, M. A., & Goodwin, C. W. (2003). Assessment of severity of ovine smoke inhalation injury by analysis of computed tomographic scans. Journal of Trauma, 55(3), 417-429. https://doi.org/10.1097/01.TA.0000083609.24440.7F