The Use of Infrared Thermography (IRT) in Burns Depth Assessment: A Diagnostic Accuracy Meta-Analysis

Abstract

Background: The timely diagnosis of burns depth is crucial to avoid unnecessary surgery and delays in adequate management of patients with burn injuries. Whilst it is mostly a clinical diagnosis, indocyanine green, laser Doppler imaging and infrared thermography have been used alongside clinical findings to support the diagnosis. Infrared thermography is a noninvasive technique which uses temperature differences to diagnose tissue burn depth. Our study aims to assess its use in differentiating between superficial and deep burns. Methods: We conducted a systematic literature review and meta-analysis using electronic databases. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity and developed hierarchical summary receiver operating characteristic (HSROC) curves. Results: We identified 6 studies reporting a total of 197 burns, of which 92 were proven to be deep burns. The reference standard was clinical assessment at the time of injury and burn healing time. The pooled estimates for sensitivity and specificity were 0.84 (95%CI 0.71–0.92) and 0.76 (95%CI 0.56–0.89), respectively. Conclusions: IRT is a promising burns assessment modality which may allow surgeons to correctly classify burn injuries at the time of presentation. This will allow a more efficient management of burns and timely surgical intervention.

Thermal Imaging as a Method to Indirectly Assess Peripheral Vascular Integrity and Tissue Viability in Veterinary Medicine: Animal Models and Clinical Applications

“…Because IRT can remotely evaluate the vascular integrity of tissues, thermal imaging has also been applied to monitor the degree of tissular damage and blood perfusion restoration [ 15 , 16 , 17 ]. Different studies in humans showed that blood flow assessment can predict the time of healing [ 15 , 53 , 54 ].…”

“…Different studies in humans showed that blood flow assessment can predict the time of healing [ 15 , 53 , 54 ]. This is of clinical relevance in burn patients in whom IRT can help to assess burn depth (e.g., superficial, superficial partial-thickness, deep partial-, or full-thickness) and estimate the recovery time [ 16 ]. These studies show that IRT can help to categorize the deepness of the injury as a primary and real-time technology for burn wound management, including surgical repair using skin grafting or free flaps to monitor tissue viability and improve the healing process [ 55 ].…”

“…The vascular damage and the altered heat transfer are physiological responses that can be monitored through IRT. Infrared evaluation applied to burn depth assessment in humans showed a sensitivity and specificity of 84% and 76%, respectively [ 16 ], while visual evaluation had an accuracy of 60% [ 59 ]. Moreover, the application of IRT could guide surgeons in deciding burn wound treatment, whether conservative or surgical [ 60 ].…”

“…For example, aortic thromboembolism cases in cats show a hypothermic response in pelvic limbs, a method that can serve to differentiate between healthy animals and those affected by the pathology [ 14 ]. Another example is burn injuries, for which determining the degree of damage is essential to adopt treatment protocols and estimate recovery time [ 15 , 16 , 17 ].…”

Infrared thermography for normal endothelial function screening

“…15 Thermal changes evaluated with infrared thermography include breast cancer, skin melanoma, burns, hemangiomas, and vascular obstruction. [16][17][18][19][20] The purpose of this study was to determine the sensitivity and specificity of thermography for evaluating normal endothelial function, given that, currently, there is no information on the subject.…”