Prospective observational study comparing burn surgeons' estimations of wound healing after skin grafting to photo-assisted methods.

Autor: Koetsier KS; University of Washington, 325 9th Ave., Seattle, WA 98104, USA. Electronic address: k.s.koetsier@lumc.nl., Wong JN; University of Alberta, 116 St & 85 Ave., Edmonton, AB T6G 2R3, Canada. Electronic address: jnw@ualberta.ca., Muffley LA; University of Washington, 325 9th Ave., Seattle, WA 98104, USA., Carrougher GJ; University of Washington, 325 9th Ave., Seattle, WA 98104, USA., Pham TN; University of Washington, 325 9th Ave., Seattle, WA 98104, USA. Electronic address: tpham94@uw.edu., Gibran NS; University of Washington, 325 9th Ave., Seattle, WA 98104, USA.
Jazyk: angličtina
Zdroj: Burns : journal of the International Society for Burn Injuries [Burns] 2019 Nov; Vol. 45 (7), pp. 1562-1570. Date of Electronic Publication: 2019 Jun 20.
DOI: 10.1016/j.burns.2019.05.013
Abstrakt: Introduction: Appropriate graft healing after split-thickness skin graft and early recognition of complications (graft loss) are critical to burn patient management. Larger mesh ratio expansions and Meek micrografting may pose a greater challenge in estimating the percentage of wound healing. This study looks at the reliability of photograph assessments and the concordance of bedside evaluation to photograph assessments of wound healing after skin grafting.
Methods: Three assessment methods for percentage of wound healing after skin Grafting were assessed: (1) clinicians' bedside rating, (2) clinician assessment of high-definition photographs, and (3) digital image analysis through color subtraction using Adobe Photoshop. We compared each method using a mixed-effects model on absolute agreement using intra-class correlation (ICC) and Bland Altman (BA) plots.
Results: Fourteen burn patients were enrolled with 38 grafted wounds (100 sites). Bedside assessments had a mean ICC of 0.64 (compared to digital image analysis) and 0.69 (compared to photo assessment), with a wide range on BA-plots. Inter-rater reliability of photo assessment was excellent (0.96) among six clinicians. Repeated photo-assisted assessments had good intra-rater reliability (ICC: photo assessment: 0.88; digital analysis: 0.97).
Conclusions: Bedside wound healing assessments show variability; photograph documentation of sequential wound progression could supplement active clinical management or studies for more reliable assessments.
(Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)
Databáze: MEDLINE
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