The prognostic role of inhalation injury in burn patients assessed by flexible bronchoscopy: a systematic review and meta-analysis

Introduction Burn-related inhalation injury may follow an unpredictable clinical course, requiring careful post-exposure monitoring. Accordingly, there is a need for an assessment tool that not only accurately characterizes the extent of airway damage but also provides reliable prognostic information. Flexible bronchoscopy is currently considered the gold standard for evaluating the severity of inhalation injury; however, the prognostic value of bronchoscopic findings in burn patients remains controversial and not fully established. Methods In this systematic review and meta-analysis, we aimed to evaluate the association between the bronchoscopically assessed severity of inhalation injury and key clinical outcomes, including mortality, hospital length of stay (HLS), intensive care unit length of stay (ICULS), duration of mechanical ventilation (VD), and the incidence of pneumonia. Results The meta-analysis demonstrated significantly higher odds of mortality in patients with severe inhalation injury compared with those with mild injury (OR = 2.83, 95% CI: 1.79–4.48, p 0.001). Statistically significant differences were also observed in HLS (pooled SMD = 0.93, 95% CI: 0.30–1.47, p = 0.002), ICULS (SMD = 0.53, 95% CI: 0.07–0.98, p = 0.02), and VD (SMD = 0.62, 95% CI: 0.19–1.06, p = 0.005), while the difference in pneumonia incidence between the high-grade and low-grade injury groups was not statistically significant (OR = 1.60, 95% CI: 0.63–4.11, p = 0.33). Conclusion The results of the meta-analysis indicate strong associations between the severity of inhalation injury, as assessed by bronchoscopy, and several key prognostic indicators in burn patients with respiratory involvement. This suggests that early bronchoscopic assessment in these patients may provide valuable information for clinical management and improved care. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024518244.