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Accuracy of laser speckle contrast imaging in the assessment of pediatric scald wounds
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics. Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences.
2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 1, p. 90-98Article in journal (Refereed) Published
Abstract [en]

Background: Changes in microvascular perfusion in scalds in children during the first four days, measured with laser speckle contrast imaging (LSCI), are related to the time to healing and need for surgical intervention. The aim of this study was to determine the accuracy (sensitivity and specificity) of LSCI on different days after injury in the prediction of healing outcome and if the accuracy can be improved by combining an early and a late measurement. Also, the accuracy of LSCI was compared with that of clinical assessment. Methods: Perfusion was measured between 0-24h and between 72-96h using LSCI in 45 children with scalds. On the same occasions, burn surgeons assessed the burns as healing amp;lt; 14days or healing amp;gt; 14days/surgery. Receiver operating characteristic (ROC) curves were constructed for the early and late measurement and for the double measurement (DM) using two different methods. Results: Sensitivity and specificity were 92.3% (95% CI: 64.0-99.8%) and 78.3% (95% CI: 69.985.3%) between 0-24h, 100% (95% CI: 84.6-100%) and 90.4% (95% CI: 83.8-94.9%) between 72-96h, and was 100% (95% CI: 59.0-100%) and 100% (95% CI: 95.1-100%) when combining the two measurements into a modified perfusion trend. Clinical assessment had an accuracy of 67%, Cohens k=0.23. Conclusion: The perfusion in scalds between 72-96h after injury, as measured using LSCI, is highly predictive of healing outcome in scalds when measured. The predictive value can be further improved by incorporating an early perfusion measurement within 24h after injury. (C) 2017 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD , 2018. Vol. 44, no 1, p. 90-98
Keywords [en]
Burn severity; Burn assessment; Scalds; Laser speckle contrast imaging
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-144874DOI: 10.1016/j.burns.2017.06.010ISI: 000422665600012PubMedID: 28797578OAI: oai:DiVA.org:liu-144874DiVA, id: diva2:1181735
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2019-11-25
In thesis
1. Blood Flow Dynamics in Burns
Open this publication in new window or tab >>Blood Flow Dynamics in Burns
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives:

Burns of intermediate thickness are hard to evaluate clinically. This often leads to unnecessary delays of up to 14 days before a surgical decision can be made. To counter this, several objective methods have been developed to determine the healing potential of the wound. Over the years, measurement of perfusion has proven to be the most successful method for evaluation of healing potential. Laser Doppler imaging (LDI) is currently the most used method and can determine surgical need 2 days after injury with an accuracy >90%.  

There are however emerging techniques like laser speckle contrast imaging (LSCI), which also measure perfusion. LSCI have several advantages over LDI and is easier to use. LSCI can also investigate aspects of the microcirculation, previously not possible with LDI. The aim of this thesis was to investigate LSCI’s ability to evaluate surgical need in burns of indeterminate partial-thickness.  

The first objective was to investigate the dynamics of perfusion the first 14 days after injury. The purpose was to find the optimal time-window for perfusion measurements. The next goal was to determine the accuracy of different perfusion cut-offs. In this second study, the benefit of a subsequent measurement was also investigated. After this, interobserver variation between different profession groups was studied. Both the agreement of perfusion measurements and observer assessments were evaluated. Finally, cardiac vasomotion in combination with perfusion (pulsatility) was investigated as a method to determine surgical need <48 hours after injury.  

Methods:

Perfusion was measured in a total of 77 patients at the Department of Plastic Surgery, Hand Surgery and Burns at Linköping University Hospital, Sweden. Most of these patients were children and the most common type of burn was scalds. A laser speckle contrast imager (PeriCam PSI System, Perimed AB, Järfälla, Sweden) was used to measure perfusion.  

Results:  

In the first paper we showed a clear relation between perfusion dynamics and the healing potential of the wound. The changes in perfusion were largest the first 5 days after injury, why this time interval was selected for subsequent papers. Perfusion measurements done day 3-4 after injury could predict surgical need with a sensitivity of 100% (95% CI: 83.9-100%) and a specificity of 90.4% (95% CI: 83.8-94.9%). If two measurements were used, <24 hours and 3-4 days after injury, the accuracy was 100%. Furthermore, we found that different observers could consistently predict perfusion, while there was a large variation in their clinical assessments. This was not improved by extensive burn experience. Finally, pulsatility could be used to predict surgical need the same day as the injury occurred with a sensitivity of 100% (95% CI: 88.1-100%) and a specificity of 98.8% (95% CI: 95.7- 99.9%).  

Conclusions:  

LSCI is a promising method for evaluation of burns and provides several benefits over LDI. The surgical need of burns can be determined mere hours after injury when pulsatility is measured. However, the benefits of early scald diagnostics in children with LSCI need to be evaluated in a prospective study before the method is ready for routine clinical use.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 83
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1720
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:liu:diva-162216 (URN)10.3384/diss.diva-162216 (DOI)9789179299453 (ISBN)
Public defence
2019-12-20, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2019-11-25 Created: 2019-11-25 Last updated: 2019-12-12Bibliographically approved

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