The Influence Of Laser Doppler Imaging On The Clinical Judgment Of Different Health Professionals For The Management Of Indeterminate Depth Burn Wounds
Mohammed Asif, MD1, Ashley Modica, MD1, An Guo Michael Chin, MSc2, Julie Caffrey, DO1, Charles Scott Hultman, MD, MBA1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
In this time of uprising telemedicine and digital health communications, photo images are often used to make preliminary assessments of burn severity and need for further management. The reliability of making a preliminary clinical assessment based on photo images is often poor, but we explore how additional information from laser Doppler imaging (LDI) can influence the clinical assessment of digital images. The aim of this study was to investigate the accuracy of burn wound images and influence of LDI to determine the need for surgical management among different healthcare providers in 100 indeterminate depth burn wounds. METHODS:
A controlled pre-test/post-test survey was conducted at a burn center to assess the influence of LDI on the clinical judgment of physicians (Group 1), nurses and physician assistants (Group 2), and other health professionals (Group 3) of whether a burn wound needed surgical or non-surgical management. The survey consisted of regular digital photographs of 100 burn wounds for the pre-test, and the same images side-by-side with 100 LDI color-coded images for the post-test. Relative risk, ANOVA, paired t-test, and intention-to-treat was used for analysis. A p value < 0.05 was considered significant.RESULTS:
A total of 6000 grader-image interactions were analyzed. There was a significant difference in the scores for pre-LDI and post-LDI surveys when all graders were considered (51.93 +/- 7.02 versus 72.87 +/- 7.93; p value < 0.0001). On average, the post-LDI score was 20.9 points higher than the pre-LDI score (95% CI [17.388, 24.478]). The post-LDI assessment was 1.4 times (RR =1.4, CI1.12-1.75) more likely to correctly predict the need for excision and skin grafting than the pre-LDI assessment alone. All professional groups had an improved performance post-LDI: group 1, 51.89 +/- 7.45 versus 76.44 +/- 5; group 2, 52.07 +/- 6.08 versus 72.71 +/- 7.67; and group 3, 51.71 +/- 9.17 versus 68.57 +/- 10.11 - no statistical difference was observed between groups (p = 0.92).CONCLUSION:
Color-coded LDI images aid the clinical judgment of digital images significantly. For every five LDI evaluation performed, one assessor had their treatment plan modified as a result of the LDI. Our study shows that digital images are unreliable in predicting burn severity and need for surgical management. LDI images can be a great supplemental tool to digital photos to increase its accuracy of determining the severity of burn wounds.
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