Hop M Jenda, Stekelenburg Carlijn M, Hiddingh Jakob, Kuipers Hedwig C, Middelkoop Esther, Nieuwenhuis Marianne K, Polinder Suzanne, van Baar Margriet E
Rotterdam, Amsterdam, Beverwijk, and Groningen, The Netherlands From the Association of Dutch Burn Centres, Maasstad Hospital; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre; the Association of Dutch Burn Centres, Red Cross Hospital; the Association of Dutch Burn Centres, Martini Hospital; and the Department of Public Health, Erasmus Medical Centre.
Plast Reconstr Surg. 2016 Jan;137(1):166e-176e. doi: 10.1097/PRS.0000000000001900.
In patients with burns, an early accurate diagnosis of burn depth facilitates optimal treatment. Laser Doppler imaging combined with clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of laser Doppler imaging on therapeutic decisions, clinical outcomes, and costs are unknown.
A randomized controlled trial was conducted in the Dutch burn centers, including 202 patients with burns of indeterminate depth. In the standard care group, estimation of burn depth was based on clinical assessment only; in the laser Doppler imaging group, clinical assessment and laser Doppler imaging were combined. Primary outcome was time to wound healing. Furthermore, therapeutic decisions and cost-effectiveness were analyzed.
Mean time to wound healing was 14.3 days (95 percent CI, 12.8 to 15.9 days) in the laser Doppler imaging group and 15.5 days (95 percent CI, 13.9 to 17.2 days) in the standard care group (p = 0.258). On the day of randomization, clinicians decided significantly more often on operative or nonoperative treatment in the laser Doppler imaging group (p < 0.001), instead of postponing their treatment choice. Analyses in a subgroup of admitted patients requiring surgery showed a significant earlier decision for surgery and a shorter wound healing time in the laser Doppler imaging group. Mean total costs per patient were comparable in both groups.
Laser Doppler imaging improved therapeutic decisions. It resulted in a shorter wound healing time in the subgroup of admitted patients requiring surgery and has the potential for cost savings of €875 per scanned patient.
对于烧伤患者，早期准确诊断烧伤深度有助于实现最佳治疗。激光多普勒成像与临床评估相结合可准确估计烧伤深度。然而，引入激光多普勒成像对治疗决策、临床结局和成本的实际影响尚不清楚。
在荷兰烧伤中心进行了一项随机对照试验，纳入202例烧伤深度不确定的患者。在标准治疗组中，仅基于临床评估来估计烧伤深度；在激光多普勒成像组中，将临床评估与激光多普勒成像相结合。主要结局是伤口愈合时间。此外，还分析了治疗决策和成本效益。
激光多普勒成像组的平均伤口愈合时间为14.3天（95%置信区间，12.8至15.9天），标准治疗组为15.5天（95%置信区间，13.9至17.2天）（p = 0.258）。在随机分组当天，激光多普勒成像组的临床医生更频繁地决定进行手术或非手术治疗（p < 0.001），而不是推迟治疗选择。对需要手术的入院患者亚组的分析显示，激光多普勒成像组手术决策明显更早，伤口愈合时间更短。两组患者的平均总费用相当。
激光多普勒成像改善了治疗决策。它使需要手术的入院患者亚组的伤口愈合时间缩短，并且有可能为每位接受扫描的患者节省875欧元的费用。
