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: 1.84). 06/2001; 27(3):233-9. DOI: 10.1016/S0305-4179(00)00118-2
Source: PubMed

ABSTRACT 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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    • "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: Laser Doppler imaging (LDI) provides early accurate determination of wound healing potential. LDI can scan large areas of up to 2500cm(2) within 2min. 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 300cm(2) 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.
    Burns: journal of the International Society for Burn Injuries 07/2014; 40(7). DOI:10.1016/j.burns.2014.04.024 · 1.84 Impact Factor
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    • "The cutaneous area of the burn can be assessed by the standard Lund and Browder burn charts. On the other hand, clinical estimation of burn depth at admission time has been shown to be highly unreliable [10] and diagnostic criteria for inhalation injury are rather vague and subjective [11]. As previously described by Fox et al. [8], a direct marker of cellular injury can provide a single objective assessment of the severity of the burn injury as a global pathological process. "
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    ABSTRACT: Background. Despite great advances in the treatment of burn patients, useful prognostic markers are sparse. During the past years there has been increasing interest in circulating plasma cell free DNA as a potential marker for tissue injury. We have developed a rapid direct fluorescent assay for cell free DNA quantification that allows obtaining accurate, fast, and inexpensive measurements. Objective. To use this technique for measuring plasma cell free DNA levels in burn patients and to further explore the use of cell free DNA as a potential marker of patient outcome in burns. Methods. Cell free DNA levels obtained from 14 burn victims within 6 hours of injury and 14 healthy controls were quantified by a direct rapid fluorometric assay. Results. Patient admission cell free DNA levels were significantly elevated compared with that of controls (1797 ± 1523 ng/mL versus 374 ± 245 ng/mL, P = 0.004). There are statistically significant correlations between cell free DNA admission levels and burn degree (Spearman's correlation = 0.78, P = 0.001), total body surface area (Spearman's correlation = 0.61, P = 0.02), and total burn volume (Spearman's correlation = 0.64, P = 0.014). Conclusions. Admission cell free DNA levels can serve as a prognostic factor in burns and future routine use can be made possible by use of our direct rapid fluorometric assay.
    BioMed Research International 06/2014; 2014:306580. DOI:10.1155/2014/306580 · 2.71 Impact Factor
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