Estimation of Burn Depth at Burn Centers in the United States

Abstract

Accurate burn depth estimation remains one of the foundations of optimal burn care. The method by which burn depth is determined has traditionally been clinical examination alone. This continues to hold true in the United States, despite a plethora of literature supporting the use of more accurate modalities such as laser Doppler imaging (LDI). LDI has widespread use in burn centers in the United Kingdom and around the world. Thus, the reason for a lack of use in U.S. burn centers remains elusive. A survey of U.S. burn center directors was conducted to assess their current practices and attitudes with regard to burn depth estimation at U.S. burn centers in an effort to answer this question. Surveys were returned from 68 burn center directors (49% response rate). All respondents reported using clinical examination in their current practice for the daily evaluation of acute burns, with a biopsy being the next most commonly used modality. The most preferred modality was also clinical examination (60%), followed by LDI (6%) and biopsy (4%). The top three modalities ranked as "most promising" for daily use were clinical examination, LDI, and noncontact/high-frequency ultrasound. Directors identified the top three limitations to the use of new technology as cost (72%), availability (63%), and lack of support by evidence to date (35%). Future studies may need to focus on overcoming these perceived limitations before the widespread use of LDI or other new modalities will be realized at burn centers in the United States.

Improving the histologic characterization of burn depth

“…The depth of thermal injury in burn patients determines the potential regenerative capacity of the tissue from epithelial progenitor cells located in the viable dermal appendages deep within the dermis. Yet, 20% to 50% of patients evaluated by an expert burn surgeon receive an incorrect prognostication of the wound healing potential . This discrepancy may lead to unnecessary skin grafting and creation of an additional wound (the donor site).…”

“…Yet, 20% to 50% of patients evaluated by an expert burn surgeon receive an incorrect prognostication of the wound healing potential. [1][2][3] This discrepancy may lead to unnecessary skin grafting and creation of an additional wound (the donor site). Conversely, waiting too long to allow wound healing to occur can lead to increased scarring, pain and functional loss due to dysfunctional wound healing.…”

Imaging Techniques for Clinical Burn Assessment with a Focus on Multispectral Imaging

“…Burn care providers have spoken clearly that improved human factors oriented designs and user-friendliness are necessary features of any commercial burn care device. 3 To this end, noncontact methods are safer and therefore more likely to be sustainable in a clinical setting. Portability, accessibility, accuracy, and cost will also play key roles in acceptance of any assistive technology.…”

“…A recently published survey highlighted laser Doppler imaging (LDI) as the technology with the most promise for future routine clinical use to determine burn depth, 3 and several devices implementing this technology are already commercially available in Europe and North America. A red or near-IR wavelength laser directed at the tissue is backscatterd by red blood cells moving through the microcirculation.…”

“…The slow adoption of technology has demonstrated that the ability to provide accurate assessment is only one facet of adoption. 3 Besides providing an accurate analysis of the burn injury, imaging devices must meet a minimum level of user and environmental requirements to be adopted for routine use. These requirements include the ability to be handled by a range of users, including nurses and surgeons, in challenging use environments such as a busy emergency room, crowded operating room, or hot and humid tank rooms where nonsurgical debridement takes place.…”