Fiber optic laryngoscopy findings in pediatric burn patients referred to the pediatric emergency department

Introduction: Facial burn injuries can compromise the airways in pediatric patients. Because prompt assessment of airway safety is a must, most assessment algorithms rely mainly on clinical judgment. There is little data on the value or utility of Fiber Optic Laryngoscopy (FOL) as an ancillary test.

Method: This retrospective analysis covered data from patients' charts at Hadassah Medical Center of all children aged 0-18 years who presented at the pediatric emergency department for facial burns and underwent FOL from January 2010 to December 2022.

Results: Over this 12-year period, 149 children were referred to the PED with scald or flash facial burns and underwent a documented FOL. Overall, there were more males than females (102; 68.4 %). There were significantly more scald burns than flash burns in toddlers (aged 2.16 ± 2.43 years; 103, 69 %). Flash burns predominated in older children (46, 30.8 %). Of the cohort, 28 (27 %) patients were admitted to the Pediatric Intensive Care Unit for scald burns and 10 (22 %) for flash burns. Findings consistent with inhalation injury identified during the FOL examination were found in 11 (7.3 %) children. The clinical finding of inhalation injury was confirmed in 17 (11.4 %) of the cases. Of these, 5 (45.5 %) had positive clinical findings suggestive of inhalation injury and 6 (54.5 %) had normal physical exam. Intubation was performed in 10 (6.7 %) of the cases. FOL had sensitivity of 29 % and specificity of 95 % for clinical findings, with NPV of 91 %.

Conclusion: The study findings suggest that the use of FOL examination in pediatric patients with facial burns and clinical signs suggestive of inhalation injury may have value, whereas its routine use presents low sensitivity comparable to reliance on clinical findings alone. Thus, FOL should be used in the patients with clinical signs of inhalation injury.