Laser doppler imaging – the role of poor burn perfusion in predicting healing time and guiding operative management. Issue 1 (February 2023)

• Record Type: Journal Article
• Authors: Shahid, Shahab; Duarte, Marco Correia; Zhang, Jufen; Markeson, Daniel; Barnes, David
• Is Part Of: Burns. Volume 49:Issue 1(2023)
• Page Start: 129
• Page End: 136
• Publication Date: 2023-02
• Subjects: Burns -- Burn perfusion -- Laser Doppler Imaging -- Intermediate depth burns -- Healing time; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2022.02.009
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Poor burn perfusion indicates deeper burn depth, and LDI is a validated tool for the assessment of burn perfusion. Poor perfusion in burns (blue) within LDI images when taken as a % of Total body surface area was not shown to independently correlate with healing time. Advanced age, increased number of comorbidities and presence of blue within a burn were found to have a statistically significant influence on healing timeand should be considered for early excision and grafting. Abstract: Aim: To identify if the proportion of poor blood flow (blue) within an LDI (Laser doppler Imaging) image of a burn independently correlates with healing time. Methods: Patient age, gender, burn type, and burn surface area were collected from the IBID (International Burn Injury Database). All LDI images were copied from the MoorLDI2-BI- Laser Doppler (MLDI) Scanner, onto Adobe Photoshop® version 2020 for pixel counting analysis and calculation of % TBSA (Total Body Surface Area) blue. Multiple linear regression analysis determined whether a proportional relationship was present for each parameter (age, gender, % TBSA Blue and comorbidities) with healing time. Results: 110 patients with 197 burns were scanned with MLDI. Median age was 5 years (IQR 1–6). Median burn surface area was 1.5% (IQR 1–2.4). 56.4% of patients were male and patients were scanned an average of 2.68 days (SD±1.37) following burn injury. Number of physical comorbidities and age were found to have a statistically significant relationship with healing time (p = 0.03, p = 0.002). Gender and %TBSA blue did not have a statistically significant relationship with healing time (p = 0.07 and p = 0.058 respectively). We found a statistically significant difference in the mean healing time between burns with and without blue (3.43 weeks vs. 2.80 weeks, p = 0.0001). % TBSA Blue was more than four times higher in the operated group (0.48% vs. 0.11%) and was shown to have a statistically significant relationship with decision to operate (p = 0.027). Positive predictive value for the presence of blue on operative rate was 71.6%. Age, gender and number of comorbidities did not have a statistically significant influence on operative rate (p = 0.07, p = 0.50 and p = 0.49). Conclusion: % TBSA blue was not found to be a reliable independent indicator of burn healing time, but the presence of blue within an LDI image, advanced patient age and increased number of comorbidities did have a statistically significant relationship with healing time. This suggests their standardised inclusion into management decisions regarding intermediate depth burns is warranted.