Pulmonary histopathologic abnormalities and predictor variables in autopsies of burned pediatric patients

Linda Sousse, David Herndon, Clark R. Andersen, Andrew Zovath, Celeste Finnerty, Ronald P. Mlcak, Robert A. Cox, Daniel L. Traber, Hal K. Hawkins

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Pulmonary abnormalities occur in 30-80% of fatalities after burn. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. Methods Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002 to 2012 (n = 43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. Results Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p < 0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p < 0.01). The scores for protein were significantly higher in cases with longer survival after burn (p < 0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p < 0.01), and in cases with the presence of inhalation injury (p < 0.01). Conclusions Histological findings associated with diffuse alveolar damage (DAD), which is the pathological correlate of the acute respiratory distress syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury.

Original languageEnglish (US)
Pages (from-to)519-527
Number of pages9
JournalBurns
Volume41
Issue number3
DOIs
StatePublished - May 1 2015

Fingerprint

Autopsy
Pediatrics
Inhalation
Lung
Adult Respiratory Distress Syndrome
Survival
Wounds and Injuries
Fibrosis
Epithelial Cells
Cell Proliferation
Pathology
Burn Units
Hyalin
Linear Models
Edema
Proteins
Air
Membranes

Keywords

  • Adult respiratory distress syndrome
  • Diffuse alveolar damage
  • Histology
  • Pediatric patients
  • Predictor variables
  • Scoring
  • Survivability

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Pulmonary histopathologic abnormalities and predictor variables in autopsies of burned pediatric patients. / Sousse, Linda; Herndon, David; Andersen, Clark R.; Zovath, Andrew; Finnerty, Celeste; Mlcak, Ronald P.; Cox, Robert A.; Traber, Daniel L.; Hawkins, Hal K.

In: Burns, Vol. 41, No. 3, 01.05.2015, p. 519-527.

Research output: Contribution to journalArticle

Sousse, L, Herndon, D, Andersen, CR, Zovath, A, Finnerty, C, Mlcak, RP, Cox, RA, Traber, DL & Hawkins, HK 2015, 'Pulmonary histopathologic abnormalities and predictor variables in autopsies of burned pediatric patients', Burns, vol. 41, no. 3, pp. 519-527. https://doi.org/10.1016/j.burns.2014.09.014
Sousse, Linda ; Herndon, David ; Andersen, Clark R. ; Zovath, Andrew ; Finnerty, Celeste ; Mlcak, Ronald P. ; Cox, Robert A. ; Traber, Daniel L. ; Hawkins, Hal K. / Pulmonary histopathologic abnormalities and predictor variables in autopsies of burned pediatric patients. In: Burns. 2015 ; Vol. 41, No. 3. pp. 519-527.
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abstract = "Pulmonary abnormalities occur in 30-80{\%} of fatalities after burn. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. Methods Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002 to 2012 (n = 43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. Results Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p < 0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p < 0.01). The scores for protein were significantly higher in cases with longer survival after burn (p < 0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p < 0.01), and in cases with the presence of inhalation injury (p < 0.01). Conclusions Histological findings associated with diffuse alveolar damage (DAD), which is the pathological correlate of the acute respiratory distress syndrome (ARDS), were seen in approximately 42{\%} of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury.",
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AU - Mlcak, Ronald P.

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N2 - Pulmonary abnormalities occur in 30-80% of fatalities after burn. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. Methods Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002 to 2012 (n = 43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. Results Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p < 0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p < 0.01). The scores for protein were significantly higher in cases with longer survival after burn (p < 0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p < 0.01), and in cases with the presence of inhalation injury (p < 0.01). Conclusions Histological findings associated with diffuse alveolar damage (DAD), which is the pathological correlate of the acute respiratory distress syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury.

AB - Pulmonary abnormalities occur in 30-80% of fatalities after burn. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. Methods Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002 to 2012 (n = 43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. Results Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p < 0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p < 0.01). The scores for protein were significantly higher in cases with longer survival after burn (p < 0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p < 0.01), and in cases with the presence of inhalation injury (p < 0.01). Conclusions Histological findings associated with diffuse alveolar damage (DAD), which is the pathological correlate of the acute respiratory distress syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury.

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