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Choi J, Patil A, Vendrow E, Touponse G, Aboukhater L, Forrester JD, Spain DA. Practical Computer Vision Application to Compute Total Body Surface Area Burn: Reappraising a Fundamental Burn Injury Formula in the Modern Era. JAMA Surg 2021; 157:129-135. [PMID: 34817552 DOI: 10.1001/jamasurg.2021.5848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Critical burn management decisions rely on accurate percent total body surface area (%TBSA) burn estimation. Existing %TBSA burn estimation models (eg, Lund-Browder chart and rule of nines) were derived from a linear formula and a limited number of individuals a century ago and do not reflect the range of body habitus of the modern population. Objective To develop a practical %TBSA burn estimation tool that accounts for exact burn injury pattern, sex, and body habitus. Design, Setting, and Participants This population-based cohort study evaluated the efficacy of a computer vision algorithm application in processing an adult laser body scan data set. High-resolution surface anthropometry laser body scans of 3047 North American and European adults aged 18 to 65 years from the Civilian American and European Surface Anthropometry Resource data set (1998-2001) were included. Of these, 1517 participants (49.8%) were male. Race and ethnicity data were not available for analysis. Analyses were conducted in 2020. Main Outcomes and Measures The contributory %TBSA for 18 body regions in each individual. Mobile application for real-time %TBSA burn computation based on sex, habitus, and exact burn injury pattern. Results Of the 3047 individuals aged 18 to 65 years for whom body scans were available, 1517 (49.8%) were male. Wide individual variability was found in the extent to which major body regions contributed to %TBSA, especially in the torso and legs. Anterior torso %TBSA increased with increasing body habitus (mean [SD], 15.1 [0.9] to 19.1 [2.0] for male individuals; 15.1 [0.8] to 18.0 [1.7] for female individuals). This increase was attributable to increase in abdomen %TBSA (mean [SD], 5.3 [0.7] to 8.7 [1.8]) among male individuals and increase in abdomen (mean [SD], 4.6 [0.6] to 6.8 [1.7]) and pelvis (mean [SD], 1.5 [0.2] to 2.9 [0.9]) %TBSAs among female individuals. For most body regions, Lund-Browder chart and rule of nines estimates fell outside the population's measured interquartile ranges. The mobile application tested in this study, Burn Area, facilitated accurate %TBSA burn computation based on exact burn injury pattern for 10 sex and body habitus-specific models. Conclusions and Relevance Computer vision algorithm application to a large laser body scan data set may provide a practical tool that facilitates accurate %TBSA burn computation in the modern era.
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Affiliation(s)
- Jeff Choi
- Department of Surgery, Stanford University, Stanford, California.,Surgeons Writing About Trauma, Stanford University, Stanford, California
| | - Advait Patil
- Surgeons Writing About Trauma, Stanford University, Stanford, California.,Department of Computer Science, Stanford University, Stanford, California.,School of Engineering, Stanford University, Stanford, California
| | - Edward Vendrow
- Surgeons Writing About Trauma, Stanford University, Stanford, California.,Department of Computer Science, Stanford University, Stanford, California
| | - Gavin Touponse
- Surgeons Writing About Trauma, Stanford University, Stanford, California.,School of Medicine, Stanford University, Stanford, California
| | - Layla Aboukhater
- Surgeons Writing About Trauma, Stanford University, Stanford, California.,School of Medicine, Stanford University, Stanford, California
| | - Joseph D Forrester
- Department of Surgery, Stanford University, Stanford, California.,Surgeons Writing About Trauma, Stanford University, Stanford, California
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, California.,Surgeons Writing About Trauma, Stanford University, Stanford, California
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Ray WC, Rajab A, Alexander H, Chmil B, Rumpf RW, Thakkar R, Viswanathan M, Fabia R. A 1%TBSA chart reduces math errors while retaining acceptable first-estimate accuracy. J Burn Care Res 2021; 43:665-678. [PMID: 34665849 PMCID: PMC9113823 DOI: 10.1093/jbcr/irab192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Life-threatening and treatment-altering errors occur in estimates of the percentage of total body surface area burned (%TBSA burned) with unacceptable frequency. In response, numerous attempts have been made to improve the charts commonly used for %TBSA-burned estimation. Recent research shows that the largest errors in %TBSA-burned estimates probably come from sources other than inaccurate values in the charts. Here, we develop a taxonomy of the possible sources of error and their impact on %TBSA-burned estimates. Also, we observe that different caregivers have different estimation needs: First-responders require a rapid estimate with sufficient accuracy to enable them to begin care and determine patient transport options, while burn surgeons ordering skin grafts desire accuracy to the square centimeter, and can afford considerable time to attain that accuracy. These competing needs suggest that a one-tool-fits-all-caregivers approach is suboptimal. We therefore present a validated, simplified burn chart that minimizes one of the largest sources of random errors in %TBSA-burned estimates—simple calculation errors—while also being quick and requiring little training. NCHart-1 also enables simple consensus estimates, as well as separation of estimation subtasks across caregivers, leading to several potential improvements in mass casualty situations. Our results demonstrate that NCHart-1 possesses the accuracy necessary for first responders, while reliably producing results in less than 2 minutes. Of 76 healthcare professionals surveyed, a large majority indicated a preference for NCHart-1 over their previous methods for ease of both use and training. For clinical or commercial use of NCHart-1, please contact: tech.commercialization@nationwidechildrens.org
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Affiliation(s)
- William C Ray
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus OH.,The Interdisciplinary Graduate Program in Biophysics at The Ohio State University, Columbus OH
| | - Adrian Rajab
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus OH
| | | | | | | | | | - Madhubalan Viswanathan
- Gies College of Business, University of Illinois, Urbana-Champaign IL.,College of Business Administration, Loyola Marymount, University, Los Angeles CA
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3
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Abstract
Burn injuries are severe problems for human. Accurate segmentation for burn wounds in patient surface can improve the calculation precision of %TBSA (total burn surface area), which is helpful in determining treatment plan. Recently, deep learning methods have been used to automatically segment wounds. However, owing to the difficulty of collecting relevant images as training data, those methods cannot often achieve fine segmentation. A burn image-generating framework is proposed in this paper to generate burn image datasets with annotations automatically. Those datasets can be used to increase segmentation accuracy and save the time of annotating. This paper brings forward an advanced burn image generation framework called Burn-GAN. The framework consists of four parts: Generating burn wounds based on the mainstream Style-GAN network; Fusing wounds with human skins by Color Adjusted Seamless Cloning (CASC); Simulating real burn scene in three-dimensional space; Acquiring annotated dataset through three-dimensional and local burn coordinates transformation. Using this framework, a large variety of burn image datasets can be obtained. Finally, standard metrics like precision, Pixel Accuracy (PA) and Dice Coefficient (DC) were utilized to assess the framework. With nonsaturating loss with R2 regularization (NSLR2) and CASC, the segmentation network gains the best results. The framework achieved precision at 90.75%, PA at 96.88% and improved the DC from 84.5 to 89.3%. A burn data-generating framework have been built to improve the segmentation network, which can automatically segment burn images with higher accuracy and less time than traditional methods.
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Affiliation(s)
- Fei Dai
- School of Computer Science, Wuhan University, Wuhan, China
| | - Dengyi Zhang
- School of Computer Science, Wuhan University, Wuhan, China
| | - Kehua Su
- School of Computer Science, Wuhan University, Wuhan, China
| | - Ning Xin
- Institute of Communication and Navigation Satellite, China Academy of Space Technology, Beijing, China
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4
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Desbois A, Beguet F, Leclerc Y, González Hernández AE, Gervais S, Perreault I, de Guise JA. Predictive Modeling for Personalized Three-Dimensional Burn Injury Assessments. J Burn Care Res 2021; 41:121-130. [PMID: 31586416 DOI: 10.1093/jbcr/irz114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For patients with major burn injuries, an accurate burn size estimation is essential to plan appropriate treatment and minimize medical and surgical complications. However, current clinical methods for burn size estimation lack accuracy and reliability. To overcome these limitations, this paper proposes a 3D-based approach-with personalized 3D models from a limited set of anthropometric measurements-to accurately assess the percent TBSA affected by burns. First, a reliability and feasibility study of the anthropometric measuring process was performed to identify clinically relevant measurements. Second, a large representative stratified random sample was generated to output several anthropometric features required for predictive modeling. Machine-learning algorithms assessed the importance and the subsets of anthropometric measurements for predicting the BSA according to specific patient morphological features. Then, the accuracy of both the morphology and BSA of 3D models built from a limited set of measurements was evaluated using error metrics and maximum distances 3D color maps. Results highlighted the height and circumferences of the bust, neck, hips, and waist as the best predictors for BSA. 3D models built from three to four anthropometric measurements showed good accuracy and were geometrically close to gold standard 3D scans. Outcomes of this study aim to decrease medical and surgical complications by decreasing errors in percent TBSA assessments and, therefore, improving patient outcomes by personalizing care.
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Affiliation(s)
- Adrien Desbois
- École de Technologie Supérieure (ÉTS), Montréal, Quebec, Canada.,Laboratoire de Recherche en Imagerie et Orthopédie (LIO)-Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Florian Beguet
- École de Technologie Supérieure (ÉTS), Montréal, Quebec, Canada.,Laboratoire de Recherche en Imagerie et Orthopédie (LIO)-Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Yannick Leclerc
- Département de Médecine Générale, Université de Montréal, Montréal (Quebec), Canada
| | | | - Sylvie Gervais
- École de Technologie Supérieure (ÉTS), Montréal, Quebec, Canada
| | - Isabelle Perreault
- Division de Chirurgie Plastique, Faculté de Médecine, Département de Chirurgie, Université de Montréal, Montréal, Quebec, Canada
| | - Jacques A de Guise
- École de Technologie Supérieure (ÉTS), Montréal, Quebec, Canada.,Laboratoire de Recherche en Imagerie et Orthopédie (LIO)-Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
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5
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Chavez-Navin M, Ali B, Choi EE, Keffer R, Cooper S, Elks W, Andujo V, Borah G. Surface Area Graphic Evaluation (SAGE) Diagram Documentation in Burn Patients: Room for Quality Improvement. Cureus 2021; 13:e13731. [PMID: 33842109 PMCID: PMC8021001 DOI: 10.7759/cureus.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The first step in the management of burn patients is an accurate estimation of the total body surface area (TBSA) involvement. Depending on which, burns are categorized as major (>20%) and minor (<20%). This then dictates fluid resuscitation and level of care. At the University of New Mexico Burn Center, we use Surface Area Graphic Evaluation (SAGE) diagramming to objectively estimate the body surface area involvement. We hypothesized patients undergoing SAGE documentation will have better outcomes. Methods This is a retrospective study of 320 consecutive patients from 2014-2018 at the University of New Mexico Burn Center. Only patients treated surgically were included. We recorded patient demographics, comorbidities, and burn details. The primary measure of interest was SAGE documentation and the secondary measure of interest was outcomes associated with it. Results We found that a SAGE diagram was only documented for a minority of patients (40%). After comparing patients in the SAGE group vs. No SAGE group, we found that the patients were the same in both groups with regards to demographics, comorbidities, and burn characteristics. The use of a SAGE diagram did not appear to be a significant predictor of complications, including surgical site infections, graft loss, donor site complications, postoperative pneumonia, urinary tract infections, deep vein thrombosis, or myocardial infarction (p=0.254). Conclusion Only a minority of patients get a SAGE diagram documented. However, our study did not find any improved outcomes with the use of a SAGE diagram. There is a need for prospective studies to validate the utility of SAGE diagramming in predicting adverse outcomes in major burns.
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Affiliation(s)
| | - Barkat Ali
- Surgery, The University of New Mexico Health Sciences Center, Albuquerque, USA
| | - EunHo Eunice Choi
- Biostatistics, The University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Ryan Keffer
- General Surgery, The University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Sydney Cooper
- General Surgery, Baylor Scott & White Health, Temple, USA
| | - Whitney Elks
- General Surgery, University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Victor Andujo
- General Surgery, Oregon Health and Science University School of Medicine, Portland, USA
| | - Gregory Borah
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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Tapking C, Houschyar KS, Rontoyanni VG, Hundeshagen G, Kowalewski KF, Hirche C, Popp D, Wolf SE, Herndon DN, Branski LK. The Influence of Obesity on Treatment and Outcome of Severely Burned Patients. J Burn Care Res 2020; 40:996-1008. [PMID: 31294797 DOI: 10.1093/jbcr/irz115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Khosrow S Houschyar
- Department of Plastic Surgery, Hand Surgery, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany
| | - Victoria G Rontoyanni
- Department of Surgery, University of Texas Medical Branch, Galveston.,Metabolism Unit, Shriners Hospitals for Children, Galveston, Texas
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | | | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Urology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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7
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Yoo KT, Woo G, Jang TY, Song JS. Comparison between the Lund-Browder chart and the BurnCase 3D® for consistency in estimating total body surface area burned. WIKIJOURNAL OF MEDICINE 2020. [DOI: 10.15347/wjm/2020.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Hosseini F, Ayatollahi H, Salehi SH, Jafar K. Teleburn: Designing A Telemedicine Application to Improve Burn Treatment. Open Med Inform J 2018; 12:33-41. [PMID: 30288202 PMCID: PMC6142640 DOI: 10.2174/1874431101812010033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 01/25/2023] Open
Abstract
Background Due to the increasing rate of the burn injuries and a limited number of specialized treatment centers, providing medical advice and medical care at the point of need is necessary. The aim of the present study was to design and implement a teleburn system to enhance the quality of care for the burn patients. Methods This study was completed in 2016. In order to design the system, information needs assessment was conducted by using a questionnaire. The participants of this phase were five specialists, five general practitioners, and 12 nurses. The setting of the study was the burn department of a public hospital and a burn center. The prototype of the system was designed based on the findings derived from the first phase, and the usability of the system was evaluated later. Results The teleburn system was a web-based system with different sections for GPs/nurses and specialists. In total, 28 burn consultations were made successfully by using the system. The findings of the usability testing showed that most of the participants evaluated the system at a good level. The mean score for the specialists, general practitioners and nurses was 8.4±0.46, 7.7±0.39, and 7.5±0.51, respectively. Conclusion Although it was the first time in the country that the teleburn system was designed and introduced to the clinicians, they seemed to be satisfied with using the system. This system could help general practitioners and nurses to receive specialist's advice on a timely manner to improve the treatment of the burn patients. However, more research should be conducted to determine the effectiveness of using this technology in the real work environment.
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Affiliation(s)
- Farhang Hosseini
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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9
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Accuracy of Currently Used Paper Burn Diagram vs a Three-Dimensional Computerized Model. J Burn Care Res 2018; 38:e254-e260. [PMID: 27294858 DOI: 10.1097/bcr.0000000000000363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Burn units have historically used paper diagrams to estimate percent burn; however, unintentional errors can occur. The use of a computer program that incorporates wound mapping from photographs onto a three-dimensional (3D) human diagram could decrease subjectivity in preparing burn diagrams and subsequent calculations of TBSA burned. Analyses were done on 19 burned patients who had an estimated TBSA burned of ≥20%. The patients were admitted to Shriners Hospitals for Children or the University of Texas Medical Branch in Galveston, Texas, from July 2012 to September 2013 for treatment. Digital photographs were collected before the patient's first surgery. Using BurnCase 3D (RISC Software GmbH, Hagenberg, Austria), a burn mapping software, the user traced partial- and full-thickness burns from photographs. The program then superimposed tracings onto a 3D model and calculated percent burned. The results were compared with the Lund and Browder diagrams completed after the first operation. A two-tailed t-test was used to calculate statistical differences. For partial-thickness burns, burn sizes calculated using Lund and Browder diagrams were significantly larger than those calculated using BurnCase 3D (15% difference, P < .01). The opposite was found for full-thickness burns, with burn sizes being smaller when calculated using Lund and Browder diagrams (11% difference, P < .05). In conclusion, substantial differences exist in percent burn estimations derived from BurnCase 3D and paper diagrams. In our studied cohort, paper diagrams were associated with overestimation of partial-thickness burn size and underestimation of full-thickness burn size. Additional studies comparing BurnCase 3D with other commonly used methods are warranted.
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10
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Hirche C, Citterio A, Hoeksema H, Koller J, Lehner M, Martinez JR, Monstrey S, Murray A, Plock JA, Sander F, Schulz A, Ziegler B, Kneser U. Eschar removal by bromelain based enzymatic debridement (Nexobrid ® ) in burns: An European consensus. Burns 2017; 43:1640-1653. [DOI: 10.1016/j.burns.2017.07.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
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11
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Hoseini F, Ayatollahi H, Salehi SH. systematized review of telemedicine applications in treating burn patients. Med J Islam Repub Iran 2016; 30:459. [PMID: 28491834 PMCID: PMC5419220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022] Open
Abstract
Background: Telemedicine has been used in different fields of medicine in the past 20 years. The main advantages of this technology include saving costs, improving quality of care, and increasing access to specialists. This study aimed to review telemedicine applications in treating burn patients. Methods: In this systematized review study, related papers were searched using various databases, including PubMed, Scopus, and Science Direct. The time frame was between January 2000 and March 2016; finally, 32 papers were included in the study. Results: The findings revealed that telemedicine was used in burn care in three different ways: Remote patient follow-up, teleconsultation, and patient assessment. Conclusion: It seems that telemedicine can be easily applied in treating burn patients even when there is a limited financial resource. The use of this technology can help reduce possible errors in categorizing burn patients and decrease patients' transportation and treatment costs.
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Affiliation(s)
- Frahang Hoseini
- MSc in Medical Informatics, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Haleh Ayatollahi
- Assistant Professor of Medical Informatics, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Hamid Salehi
- Associate Professor of General Surgery, Iran University of Medical Sciences, Tehran, Iran.
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Ziegler B, Hirche C, Horter J, Kiefer J, Grützner PA, Kremer T, Kneser U, Münzberg M. In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland. Burns 2016; 43:318-325. [PMID: 27665246 DOI: 10.1016/j.burns.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. MATERIAL AND METHODS A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. RESULTS 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. CONCLUSION While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence.
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Affiliation(s)
- Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Johannes Horter
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Jurij Kiefer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Thomas Kremer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany.
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13
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Staruch RMT, Beverly A, Lewis D, Wilson Y, Martin N. Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling. J ROY ARMY MED CORPS 2016; 163:58-64. [PMID: 27278968 DOI: 10.1136/jramc-2015-000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/04/2022]
Abstract
AIMS While the epidemiology of amputations in patients with burns has been investigated previously, the effect of an amputation on burn size and its impact on fluid management have not been considered in the literature. Fluid resuscitation volumes are based on the percentage of the total body surface area (%TBSA) burned calculated during the primary survey. There is currently no consensus as to whether the fluid volumes should be recalculated after an amputation to compensate for the new body surface area. The aim of this study was to model the impact of an amputation on burn size and predicted fluid requirement. METHODS A retrospective search was performed of the database at the Queen Elizabeth Hospital Birmingham Regional Burns Centre to identify all patients who had required an early amputation as a result of their burn injury. The search identified 10 patients over a 3-year period. Burn injuries were then mapped using 3D modelling software. BurnCase3D is a computer program that allows accurate plotting of burn injuries on a digital mannequin adjusted for height and weight. Theoretical fluid requirements were then calculated using the Parkland formula for the first 24 h, and Herndon formula for the second 24 h, taking into consideration the effects of the amputation on residual burn size. RESULTS AND CONCLUSIONS This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes.
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Affiliation(s)
- Robert M T Staruch
- School of Engineering & Applied Sciences, Harvard University, USA.,Department of Burns and Plastic Surgery, St Marys Hospital, Imperial College Healthcare, London, UK
| | - A Beverly
- Department of Anaesthetics, Royal Surrey County Hospital, Guildford, UK
| | - D Lewis
- Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Y Wilson
- Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - N Martin
- Department of Burns & Plastic Surgery, St Andrews Centre for Burns & Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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Benjamin NC, Wurzer P, Voigt CD, Benjamin DA, Herndon DN. Using a 3D tool to document and determine graft loss: A mini-review and case report. Burns 2016; 42:e65-9. [DOI: 10.1016/j.burns.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
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Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. BURNS & TRAUMA 2016; 4:14. [PMID: 27574684 PMCID: PMC4964074 DOI: 10.1186/s41038-016-0036-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. METHODS A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. RESULTS After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. CONCLUSIONS Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.
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Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Liam Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Ann Logan
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Naiem Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
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BurnCase 3D software validation study: Burn size measurement accuracy and inter-rater reliability. Burns 2016; 42:329-35. [PMID: 26839051 DOI: 10.1016/j.burns.2016.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/27/2015] [Accepted: 01/03/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the accuracy of burn size estimation using the computer-assisted software BurnCase 3D (RISC Software GmbH, Hagenberg, Austria) with that using a 2D scan, considered to be the actual burn size. METHODS Thirty artificial burn areas were pre planned and prepared on three mannequins (one child, one female, and one male). Five trained physicians (raters) were asked to assess the size of all wound areas using BurnCase 3D software. The results were then compared with the real wound areas, as determined by 2D planimetry imaging. To examine inter-rater reliability, we performed an intraclass correlation analysis with a 95% confidence interval. RESULTS The mean wound area estimations of the five raters using BurnCase 3D were in total 20.7±0.9% for the child, 27.2±1.5% for the female and 16.5±0.1% for the male mannequin. Our analysis showed relative overestimations of 0.4%, 2.8% and 1.5% for the child, female and male mannequins respectively, compared to the 2D scan. The intraclass correlation between the single raters for mean percentage of the artificial burn areas was 98.6%. There was also a high intraclass correlation between the single raters and the 2D Scan visible. CONCLUSION BurnCase 3D is a valid and reliable tool for the determination of total body surface area burned in standard models. Further clinical studies including different pediatric and overweight adult mannequins are warranted.
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Wurzer P, Parvizi D, Lumenta DB, Giretzlehner M, Branski LK, Finnerty CC, Herndon DN, Tuca A, Rappl T, Smolle C, Kamolz LP. Smartphone applications in burns. Burns 2015; 41:977-89. [DOI: 10.1016/j.burns.2014.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Toussaint J, Singer AJ. The evaluation and management of thermal injuries: 2014 update. Clin Exp Emerg Med 2014; 1:8-18. [PMID: 27752547 PMCID: PMC5052819 DOI: 10.15441/ceem.14.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 08/21/2014] [Accepted: 08/28/2014] [Indexed: 11/23/2022] Open
Abstract
Burns are among the most common injuries presenting to the emergency department. While burns, especially large ones, may be associated with significant morbidity and mortality, most are minor and can be managed by emergency practitioners and discharged home with close follow-up. In contrast, patients with large burns require aggressive management of their airway, breathing and circulation in order to reduce mortality and morbidity. While early endotracheal intubation of patients with actual or impending airway compromise and aggressive fluid resuscitation have been emphasized, it appears that the pendulum may have swung a bit too far towards the extreme. The current review will briefly cover the epidemiology, pathogenesis and diagnosis of burn injuries with greater emphasis on airway and fluid management. We will also discuss the local management of the burn wound, which is all that is required for most burn patients in the emergency department.
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Affiliation(s)
- Jimmy Toussaint
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA
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Sheng WB, Zeng D, Wan Y, Yao L, Tang HT, Xia ZF. BurnCalc assessment study of computer-aided individual three-dimensional burn area calculation. J Transl Med 2014; 12:242. [PMID: 25204349 PMCID: PMC4173062 DOI: 10.1186/s12967-014-0242-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate estimation of a burned area is crucial to decisions about fluid resuscitation, surgical options, nutritional support, and prognosis. Widely used clinical methods to estimate a burn area are two-dimensional. They do not consider age, sex, body mass, physical deformities, or other relevant factors. Computer-aided methods have improved the accuracy of estimating burned areas by including data analysis and reducing subjective differences. Three-dimensional (3D) scanning allows us to determine body dimensions rapidly and reproducibly. We describe an individualized, cost-efficient, portable 3D scanning system, BurnCalc, that can create an individual 3D model and then calculate body surface area (BSA) and the burn area accurately and quickly. METHODS The BurnCalc system was validated by verifying the accuracy and stability of BSA calculation. We measured 10 regular objects in experiment 1, using Student's t-test and the intraclass correlation coefficient (ICC) in the analysis. In experiment 2, artificial paper patches of known dimensions were attached to various parts of the body of 40 volunteers. Their sizes were then calculated using BurnCalc. The BurnCalc data were compared to actually measured values to verify accuracy and stability. Total BSAs of these 40 volunteers were also calculated by BurnCalc and compared to those derived from an accepted formula. In experiment 3, four experts using Chinese Rule-of-Nines or Rule-of-Palms methods calculated the percentages of the total BSA in 17 volunteers. Student's t-test and ICC, respectively, were used to compare the results obtained with the BurnCalc technique. RESULTS Statistically, in experiment 1, p = 0.834 and ICC = 0.999, demonstrating that there was no difference between the BurnCalc and real measurements. Also, the hypothesis of null difference among measures (experiment 2) was true because p > 0.05 and ICC = 0.999, indicating that calculations of the total BSA and the burn area were more accurate using the BurnCalc technology. The reliability of the BurnCalc program was 99.9%. In experiment 3, only the BurnCalc method exhibited values of p > 0.05 (p = 0.774) and ICC = 0.999. CONCLUSIONS BurnCalc technology produced stable, accurate readings, suggesting that BurnCalc could be regarded as a new standard clinical method.
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Affiliation(s)
- Wen-bo Sheng
- Department of Burns, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ding Zeng
- Department of Burns, The Second Artillery General Hospital, Beijing, China
| | - Yan Wan
- School of Computer Science and Technology, Donghua University, Shanghai, China
| | - Li Yao
- School of Computer Science and Technology, Donghua University, Shanghai, China
| | - Hong-tai Tang
- Department of Burns, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhao-fan Xia
- Department of Burns, Changhai Hospital, Second Military Medical University, Shanghai, China
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Urschler M, Höller J, Bornik A, Paul T, Giretzlehner M, Bischof H, Yen K, Scheurer E. Intuitive presentation of clinical forensic data using anonymous and person-specific 3D reference manikins. Forensic Sci Int 2014; 241:155-66. [PMID: 24952238 DOI: 10.1016/j.forsciint.2014.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 11/16/2022]
Abstract
The increasing use of CT/MR devices in forensic analysis motivates the need to present forensic findings from different sources in an intuitive reference visualization, with the aim of combining 3D volumetric images along with digital photographs of external findings into a 3D computer graphics model. This model allows a comprehensive presentation of forensic findings in court and enables comparative evaluation studies correlating data sources. The goal of this work was to investigate different methods to generate anonymous and patient-specific 3D models which may be used as reference visualizations. The issue of registering 3D volumetric as well as 2D photographic data to such 3D models is addressed to provide an intuitive context for injury documentation from arbitrary modalities. We present an image processing and visualization work-flow, discuss the major parts of this work-flow, compare the different investigated reference models, and show a number of cases studies that underline the suitability of the proposed work-flow for presenting forensically relevant information in 3D visualizations.
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Affiliation(s)
- Martin Urschler
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4, 8010 Graz, Austria; Institute for Computer Graphics and Vision, BioTechMed, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria.
| | - Johannes Höller
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4, 8010 Graz, Austria
| | - Alexander Bornik
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4, 8010 Graz, Austria; Institute for Computer Graphics and Vision, BioTechMed, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria
| | - Tobias Paul
- Department of Anthropology, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Michael Giretzlehner
- Research Unit Medical Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria
| | - Horst Bischof
- Institute for Computer Graphics and Vision, BioTechMed, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria
| | - Kathrin Yen
- Institute for Forensic and Traffic Medicine, University of Heidelberg, Voßstraße 2, Heidelberg, Germany
| | - Eva Scheurer
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4, 8010 Graz, Austria; Department of Legal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8010 Graz, Austria
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Kamolz LP, Parvizi D, Giretzlehner M, Lumenta DB. Burn surface area calculation: What do we need in future. Burns 2014; 40:171-2. [DOI: 10.1016/j.burns.2013.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 11/25/2022]
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Parvizi D, Kamolz LP, Giretzlehner M, Haller HL, Trop M, Selig H, Nagele P, Lumenta DB. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind. Burns 2013; 40:241-5. [PMID: 24050977 DOI: 10.1016/j.burns.2013.06.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 06/15/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Accurate estimation of burn size is of critical importance, as it is incorporated in every resuscitation formula. The aim of this study was to investigate total burn surface area (TBSA) accuracy among burn specialists, evaluate the potential impact of incorrect evaluation on variations of resultant fluid resuscitation volumes and to discuss future possibilities to estimate or measure TBSA more precisely. METHODS In a poll during two international burn meetings in 2010 and 2011 demonstrating three pictures of patients with different burn wound patterns and sizes we asked participants to estimate the total surface area burned in percentages. We then calculated resultant fluid volume differences based on established resuscitation formulas. RESULTS In the polled 80 participants, the estimations for three patients demonstrated the following differences (DIF=MAX-MIN): for patient 1, 2 and 3 they were 22.5 (25-2.5), 16.5 (20-3.5) and 31.5 (40-8.5) %TBSA, respectively. Based on these differences we calculated the volume differences for patients 1,2 and 3, which were 1080ml (Cincinnati Formula), 5280ml (Parkland Formula) and 2016ml (Cincinnati Formula), respectively. CONCLUSIONS The analysis showed high deviations of total body surface area among participants, also resulting in large variations of initial fluid resuscitation volumes. One option to address estimation variances is to perform more accurate assessments; also incorporating new technologies aiding to improve the quality of body surface estimations and related decisions.
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Affiliation(s)
- Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Michael Giretzlehner
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria.
| | | | - Maria Trop
- Pediatric Burn Unit, Department of Pediatrics, Medical University of Graz, Graz, Austria.
| | - Harald Selig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria; Department of Hand, Plastic and Reconstructive Surgery with Burn Unit, Eberhard-Karls-University of Tuebingen, BG Trauma Center, Tuebingen, Germany.
| | - Peter Nagele
- Department of Anaesthesiology, Washington University School of Medicine, St. Louis, USA
| | - David B Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria.
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The determination of total burn surface area: How much difference? Burns 2013; 39:1107-13. [PMID: 23566430 DOI: 10.1016/j.burns.2013.01.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/27/2012] [Accepted: 01/07/2013] [Indexed: 11/24/2022]
Abstract
Burn depth and burn size are crucial determinants for assessing patients suffering from burns. Therefore, a correct evaluation of these factors is optimal for adapting the appropriate treatment in modern burn care. Burn surface assessment is subject to considerable differences among clinicians. This work investigated the accuracy among experts based on conventional surface estimation methods (e.g. "Rule of Palm", "Rule of Nines" or "Lund-Browder Chart"). The estimation results were compared to a computer-based evaluation method. Survey data was collected during one national and one international burn conference. The poll confirmed deviations of burn depth/size estimates of up to 62% in relation to the mean value of all participants. In comparison to the computer-based method, overestimation of up to 161% was found. We suggest introducing improved methods for burn depth/size assessment in clinical routine in order to efficiently allocate and distribute the available resources for practicing burn care.
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Dirnberger J, Michael G, Robert O, Herbert H, Peter KL. Comments on "a system for 3D representation of burns and calculation of burnt skin area". Burns 2012; 38:1091-3; author reply 1093-4. [PMID: 22657585 DOI: 10.1016/j.burns.2012.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
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Epidemiology and impact of scarring after burn injury: a systematic review of the literature. J Burn Care Res 2012; 33:136-46. [PMID: 22138807 DOI: 10.1097/bcr.0b013e3182374452] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to perform a systematic review of the existing literature on the incidence of hypertrophic scarring and the psychosocial impact of burn scars. In a comprehensive literature review, the authors identified 48 articles published since 1965 and written in English which reported the incidence and risk factors for hypertrophic scarring or assessed outcomes related to scarring. Most studies had important methodological limitations limiting the generalizability of the findings. In particular, the absence of standardized valid measures of scarring and other outcome variables was a major barrier to drawing strong conclusions. Among studies on hypertrophic scarring, the prevalence rate varied between 32 and 72%. Identified risk factors included dark skin, female gender, young age, burn site on neck and upper limb, multiple surgical procedures, meshed skin graph, time to healing, and burn severity. With regard to psychosocial outcomes, two studies compared pediatric burn survivors with a nonburn comparison group on a body image measure; neither study found differences between groups. Across studies, burn severity and location had a modest relationship with psychosocial outcome variables. Psychosocial variables such as social comfort and perceived stigmatization were more highly associated with body image than burn characteristics. To advance our knowledge of the epidemiology of scars and the burden of scars, future studies need to implement more rigorous methodologies. In particular, standardized valid measures of scarring and other outcomes should be developed. This process could be facilitated by an international collaboration among burn centers.
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Chan QE, Barzi F, Cheney L, Harvey JG, Holland AJA. Burn size estimation in children: still a problem. Emerg Med Australas 2011; 24:181-6. [PMID: 22487668 DOI: 10.1111/j.1742-6723.2011.01511.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Accurate determination of burn size and depth forms an integral part of the initial assessment of any burn injury. Errors might lead to inaccurate fluid resuscitation and inappropriate transfer of patients to specialized burns units (BUs). Although recent data suggest some improvement in the estimation of burn injury in adults, this has not been shown in children. METHODS A retrospective review of children with burn injuries referred to the BU of our institution was performed. Data were collected from all patients presenting to the BU during the calendar year 2009. The total body surface area burned (TBSA-B) estimated by the referring centre was compared with the actual TBSA determined measured on arrival at the BU. RESULTS Of the 71 paediatric patients referred during the study period, 10 did not have any TBSA-B estimation documented by the referring hospital. Inaccurate estimation of burn area was noted in 48 out of 61 patients (79%). Burn size was more likely to be overestimated than underestimated by a ratio of 2.2 to 1, especially in burns >10% TBSA-B (P= 0.002). CONCLUSIONS Inaccurate estimation of burn size remains a problem in children. The persistent miscalculation of burn size might be a result of the various methods employed in assessing burn area, the inclusion of simple erythema and inadequate training or exposure of first responders. Accurate assessment of TBSA-B and burn depth in children remains elusive and would appear to require additional training and education.
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Affiliation(s)
- Queenie E Chan
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital Burns Research Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Prieto MF, Acha B, Gómez-Cía T, Fondón I, Serrano C. A system for 3D representation of burns and calculation of burnt skin area. Burns 2011; 37:1233-40. [PMID: 21703768 DOI: 10.1016/j.burns.2011.05.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 11/25/2022]
Abstract
In this paper a computer-based system for burnt surface area estimation (BAI), is presented. First, a 3D model of a patient, adapted to age, weight, gender and constitution is created. On this 3D model, physicians represent both burns as well as burn depth allowing the burnt surface area to be automatically calculated by the system. Each patient models as well as photographs and burn area estimation can be stored. Therefore, these data can be included in the patient's clinical records for further review. Validation of this system was performed. In a first experiment, artificial known sized paper patches were attached to different parts of the body in 37 volunteers. A panel of 5 experts diagnosed the extent of the patches using the Rule of Nines. Besides, our system estimated the area of the "artificial burn". In order to validate the null hypothesis, Student's t-test was applied to collected data. In addition, intraclass correlation coefficient (ICC) was calculated and a value of 0.9918 was obtained, demonstrating that the reliability of the program in calculating the area is of 99%. In a second experiment, the burnt skin areas of 80 patients were calculated using BAI system and the Rule of Nines. A comparison between these two measuring methods was performed via t-Student test and ICC. The hypothesis of null difference between both measures is only true for deep dermal burns and the ICC is significantly different, indicating that the area estimation calculated by applying classical techniques can result in a wrong diagnose of the burnt surface.
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Affiliation(s)
- María Felicidad Prieto
- Servicio de Cirugía Plástica y Grandes Quemados, Hospitales U, Virgen del Rocío, Seville, Spain
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