Photographic assessment of burn wounds: A simple strategy in a resource-poor setting

Kiser, Michelle; Beijer, Gustaf; Mjuweni, Stephen; Muyco, Arturo P; Cairns, Bruce A.; Charles, Anthony

doi:10.1016/j.burns.2012.04.003

Cited by 33 publications

(41 citation statements)

References 31 publications

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“…It has already been documented that burn size can be assessed using photographs on patients with light-skin types [17,23] and there were indications that this applied even to those with dark-skin types [20]. We confirmed that burn size can be appropriately diagnosed on dark-skin types and even more so by specialised physicians familiar with cases of that type.…”

Section: Discussionsupporting

confidence: 78%

“…In the literature at hand, image-based diagnosis was compared to the bedside diagnosis made by the same assessor [16,[19][20][21]23]. In the current study the diagnosis was determined at bedside by a burn surgeon in service when the patient was treated.…”

Section: Discussionmentioning

confidence: 99%

“…An additional drawback is that except for one recent study [20], evidence rests largely on observations from patients with light skin, whereas burns on patients with dark-skin types may pose particular diagnostic problems [24,25]. Furthermore, whereas the assessment of both burn depth and size has been regarded as accurate [16,[18][19][20][21]23,26], a recent study using laser Doppler as a gold standard for burn depth has questioned these results [17].…”

Section: Introductionmentioning

confidence: 94%

“…Studies indicate that image-based teleconsultation for injury emergency care in general, and burns in particular, is an effective and reliable tool for communication [15]. More specifically, a number of studies have looked at the feasibility of using photographic support for remote burn diagnosis [16][17][18][19][20][21][22], including photographs taken by camera phones [20,23]. The evidence accumulated suggests that relatively accurate diagnoses can be made on both burn size and depth, and that some patient (age) and assessor (specialisation, experience) characteristics affect the results reached, e.g.…”

Section: Introductionmentioning

confidence: 98%

“…The evidence accumulated suggests that relatively accurate diagnoses can be made on both burn size and depth, and that some patient (age) and assessor (specialisation, experience) characteristics affect the results reached, e.g. diagnostic accuracy, specificity, and reliability [16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Photograph-based diagnosis of burns in patients with dark-skin types: The importance of case and assessor characteristics

Boissin

Laflamme

Wallis

et al. 2015

Burns

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Photograph-based diagnosis of burns in patients with dark-skin types: The importance of case and assessor characteristics

Boissin

Laflamme

Wallis

et al. 2015

Burns

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Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource‐Limited Setting in Sub‐Saharan Africa

et al. 2020

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Introduction Early excision and grafting remains the standard of care after burn injury. However, in a resourcelimited setting, operative capacity often limits patient access to surgical intervention. This study sought to describe access to excision and grafting for adult burn patients in a sub-Saharan African burn unit and its relationship with burn-associated mortality. Methods We analyzed patients recorded in the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi from 2011-2019. We examined patient characteristics, interventions, and outcomes for adults aged C16 years. Modified Poisson regression modeling was used to identify risk factors for mortality. Results Five hundred and seventy-three patients were included. Median age was 30 years (IQR 23-40) with a male preponderance (63%). Median percent total body surface area burned (%TBSA) was 15% (IQR 8-26) and 68% of burns were caused by flame. 27% (n = 154) had burn excision with skin grafting, with a median time to operation of 18 days (IQR 9-38). When adjusted for age, %TBSA, and time to presentation, operative intervention conferred a survival benefit for patients with flame burns with a RR 0.16 (95% CI 0.06, 0.42). Conclusions In a resource-limiting setting, access to the operating room is inadequate, and burn patients are not prioritized. While many scald burn patients may be managed with wound care alone, patients with flame burn require surgical intervention to improve clinical outcomes. Burn injury in this region continues to confer a high risk of mortality, and more investment in operative capacity is imperative.

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The Association Between Burn Unit Census and Operative Intervention in a Resource‐Limited Setting

et al. 2021

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Introduction The relationship between hospital volume and outcomes remains unclear in the delivery of burn care in resource‐limited settings, where demand often exceeds capacity. We sought to characterize the association between burn patient volume and the use of operative intervention at a tertiary burn unit in Malawi. Methods This study examined patients admitted to Kamuzu Central Hospital located in Lilongwe, Malawi, over years 2011–2019. We described the association between the census at the time of admission and the use of operative intervention, as well as the time to operation. Patient census was defined as low (≤ 15 patients), medium (16–29 patients), and high (≥ 30 patients). Results A total of 2484 patients were included. The mean daily burn unit census was 22.5 patients (SD 6.6) and varied significantly by season. For the medium and high census, the adjusted risk ratio of undergoing surgery was 0.79 (95% CI 0.64, 0.97) and 0.65 (95% CI 0.49, 0.85), respectively, adjusted for flame burn, age, %TBSA, and delayed presentation. At a low admission census, the adjusted mean time to operation was 17.2 days (95% CI 14.4, 20.1) compared to 28.3 days (95% CI 25.4, 31.2) at a high census. Conclusions In a resource‐limited setting, an increasing mean daily census significantly reduced the use of operative intervention and increased time to operation, potentially increasing burn‐associated morbidity. In order to improve the quality of burn care in similar environments, improved resource allocation during busier seasons and targeted burn prevention efforts are imperative.

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Photographic assessment of burn wounds: A simple strategy in a resource-poor setting

Abstract: Burn assessment with digital photography is a valid and affordable alternative to direct clinical exam, alleviating access issues to burn care in developing countries.

Cited by 33 publications

References 31 publications

Photograph-based diagnosis of burns in patients with dark-skin types: The importance of case and assessor characteristics

Photograph-based diagnosis of burns in patients with dark-skin types: The importance of case and assessor characteristics

Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource‐Limited Setting in Sub‐Saharan Africa

The Association Between Burn Unit Census and Operative Intervention in a Resource‐Limited Setting

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