Author(s)
Emma Thompson, BA 1
Gloria Abbas-Zadeh, BA 1
Nour Abdel-Azim, MD, MPH2
Rachel Kaye, MD, FACS 1
Kenneth Yan, MD, PhD1
Affiliation(s)
1 Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
2 Department of Otolaryngology, Loma Linda University Health, 11234 Anderson Street, Loma Linda, California
Abstract:
Introduction: Fire-related inhalational injuries are perceived as more dangerous than other forms of caustic inhalations, with findings such as soot in the nares justifying early airway interventions. However, evidence supporting this remains limited. This study characterized inhalational injury patterns among patients presenting to U.S. emergency departments and evaluated whether fire involvement was associated with worse outcomes.
Methods: Data was extracted from the 2004-2023 National Electronic Injury Surveillance System. Cases involving foreign bodies, water, medications, drug ingestions, or exercise injuries were excluded. Outcome variables included age, sex, race, product inhaled, and fire involvement. Weighted analyses were conducted in SPSS and R, with p<0.05 considered statistically significant.
Results: A total of 14,818 unweighted inhalations met inclusion criteria. The mean age was 37.6 ± 22.0 years, 52.9% were male, and 62.7% were White. Nearly half (45.9%) of cases were non-fire-associated inhalations (nFAI), but fire-associated inhalations (FAI) were more likely in older patients (39.1 ± 23.2 vs 35.9 ± 20.4 years, p < 0.001) and males (p < 0.001). FAI were also more likely to result in admission, transfer, or fatality (p<0.001). nFAI outcomes differed by product (p<0.001), with bleach exposures being more commonly treated and released (90.9%) and less likely to require admission (4.8%) or transfer (0.3%) when compared to household cleaner and swimming pool chemical inhalations.
Conclusions: FAI occurred in older patients and were associated with more severe outcomes, while nFAI outcomes varied by product type. These findings suggest fire exposure inhalations represent a distinct, higher-risk subset warranting targeted management.