Integrity of airway epithelium in pediatric burn autopsies: Association with age and extent of burn injury

• Epithelial loss statistically correlates with TBSA and age.
• Epithelial loss did not correlate with time of tissue fixation.
• No difference in integrity scores between inhalation and burn only victims.
• Loss of the epithelium can promote mucostasis and pneumonia.

This study examines the structural integrity of the airway epithelium in autopsy tissues from pediatric burn subjects.MethodsA semi-quantitative score for the degree of airway epithelial integrity was made for seventy- two pediatric burn autopsies. Multivariate ordinal logistic regression was performed to identify relationships between epithelial integrity and conditions related to tissue fixation, time of death after injury, age, total body surface area burn (TBSA), extent of 3rd degree burn, presence of inhalation injury, ventilator days and pneumonia.ResultsNo significant difference in epithelial integrity scores was identified between burn only cases and those with inhalation injury. Significant correlations with bronchiolar epithelial integrity scores were identified for age, p = 0.02, and percent 3rd degree burn, p = 0.02. There was no significant relationship between epithelial integrity and time between death and autopsy, p > 0.44.ConclusionsAirway epithelial loss seen in autopsy tissue is not simply an artifact of tissue fixation. The degree of compromise correlates most strongly with age and degree of burn. Further studies are needed to identify physiological or critical care factors following burn injury that contribute to compromise in the structural and functional properties of the airway epithelium.