Xenon Ventilation-Perfusion Lung Scans

To the Editor.—  In their article "Xenon Ventilation-Perfusion Lung Scans: The Early Diagnosis of Inhalation Injury," Schall et al (240:2441, 1978) suggest that the "widespread application of this test will reduce the mortality associated with severe thermal burns." Their study has shown that ventilation-perfusion lung scan is a sensitive test in detecting inhalation injury early in its course. If bronchoscopy is considered the diagnostic standard, the lung scan was abnormal in 21 of 21 patients with abnormal bronchoscopic results. However, if the authors recommend using the ventilation-perfusion scan as a screening test for inhalation injury in most major thermal burn patients, I cannot agree. By the authors' admission, the benefits of using methylprednisolone early in inhalation injury are unproved. Assuming that all patients with major burns are monitored closely for respiratory problems from thermal injury, how would early detection by screening alter the care of these patients, and would early