An audit of the use of laser-Doppler Imaging (LDI) in the assessment of burns of intermediate depth

Royal Victoria Infirmary, NE1 4LP, Newcastle upon Tyne, UK.
Burns (Impact Factor: 1.88). 06/2001; 27(3):233-9. DOI: 10.1016/S0305-4179(00)00118-2
Source: PubMed


This is the first report of an evaluation of the use of a laser Doppler imager (LDI) scanner in the assessment of burn depth in patients. It is based on a 6-month, prospective audit of 76 burns of intermediate depth. Clinical and LDI assessments of burn wound depth were recorded at 48-72 h post-injury. Histological confirmation of depth was obtained from those burns requiring surgery. A healing time of less than 21 days was taken as confirmation of the injury being an superficial dermal burn. The accuracy of LDI in the assessment of burn depth was 97%, compared with 60-80% for established clinical methods. This audit confirms that LDI is a very accurate measurement tool for the assessment of burn wound depth. We recommend that all burns of intermediate depth should be analysed in this way in order to ensure appropriate management of the burn, to avoid unnecessary surgery and to reduce hospital stay and costs.

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    • "Such a tool could also enhance pre-operative planning by providing the clinician with a wound map of burn depth gradients, estimated excision depths, and donor skin area approximations. The most salient potential solutions to improve burn depth estimation include fluorescent dyes, high frequency ultrasound , nuclear imaging (MRI), photography, thermography, and laser Doppler imaging (LDI) [7]. A side by side comparison of these technologies is presented in Table 1. "
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    ABSTRACT: Multispectral imaging (MSI) is an optical technique that measures specific wavelengths of light reflected from wound site tissue to determine the severity of burn wounds. A rapid MSI device to measure burn depth and guide debridement will improve clinical decision making and diagnoses. We used a porcine burn model to study partial thickness burns of varying severity. We made eight 4×4cm burns on the dorsum of one minipig. Four burns were studied intact, and four burns underwent serial tangential excision. We imaged the burn sites with 400-1000nm wavelengths. Histology confirmed that we achieved various partial thickness burns. Analysis of spectral images show that MSI detects significant variations in the spectral profiles of healthy tissue, superficial partial thickness burns, and deep partial thickness burns. The absorbance spectra of 515, 542, 629, and 669nm were the most accurate in distinguishing superficial from deep partial thickness burns, while the absorbance spectra of 972nm was the most accurate in guiding the debridement process. The ability to distinguish between partial thickness burns of varying severity to assess whether a patient requires surgery could be improved with an MSI device in a clinical setting. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
    Burns: journal of the International Society for Burn Injuries 06/2015; DOI:10.1016/j.burns.2015.05.009 · 1.88 Impact Factor
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    • "Wounds that were deemed to be hyperperfused were managed conservatively with daily dressings and wounds deemed to be hypoperfused were managed surgically within the first 24 h of presentation. They found that the accuracy of LD assessment was 97% compared to 70% by clinical assessment [12]. It is imperative to mention that in 4 cases, the clinician ignored the judgement of the LD assessment, which judged the wound to heal within 21 days, and the cases were taken to theatre for excision and grafting. "
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    ABSTRACT: Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging (LDI) techniques. Methods. A systematic search for relevant literature was carried out on PubMed, Medline, EMBASE, and Google Scholar. Key search terms included the following: “Laser Doppler imaging,” “laser Doppler flow,” and “burn depth.” Results. A total of 53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions. The numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one. Despite the presence of alternative burn depth assessment techniques, LDI remains the most favoured. Various newer LDI machines with increasingly sophisticated methods of assessing burn depth have been introduced throughout the years. However, factors such as cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral vascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research.
    08/2014; 2014. DOI:10.1155/2014/621792
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    • "An audit of the use of LDI in the assessment of burn depth [15] found 97% accuracy with LDI compared to 60–80% accuracy for established clinical methods alone. It was also reported that use of LDI resulted in a reduction of both costs and workload [15] and that LDI enabled earlier and more objective determination of the need to excise and graft burns [16]. In a further study, additional assessments at several postburn days showed the accuracies for LDI were 95–97% compared to 52.5–71.4% for clinical evaluation at day 3 and day 5 post-burn respectively [17]. "
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    ABSTRACT: Introduction: Laser Doppler imaging (LDI) provides early accurate determination of wound healing potential. LDI can scan large areas of up to 2500 cm2 within 2 min. This duration may require additional sedation in a mobile, uncooperative child. In five burn centres a faster Laser Doppler Line Scanner (LDLS) was assessed. This new imager scans 300 cm2 in 4s with potential benefit for patients and operators. The aim of this study was to assess the accuracy and convenience of the LDLS and to compare this with an established LDI imager. Methods: Outpatients and admitted patients were included. LDI and LDLS images were obtained between 2 and 5 days post burn (PB). Photographs and records of wound and healing were obtained on day of scan and at 14 and 21 days PB. This provided data on three categories of burn wounds: healing within 14 days, 14-21 days and not healed within 21 days. Results: The analysis included 596 burn areas from 204 burns patients. An accuracy of 94.2% was found with use of the LDLS compared with 94.4% for the original LDI imager. Conclusions: The high accuracy of the new line-scan imager was comparable to that of the traditional LDI. Its size and mobility enabled easier ward and outpatient use. The higher scan speed was particularly beneficial for scans in paediatric patients.
    Burns: journal of the International Society for Burn Injuries 07/2014; 40(7). DOI:10.1016/j.burns.2014.04.024 · 1.88 Impact Factor
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