Retrouvey Helene, Chan Justin, Shahrokhi Shahriar
Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, D716, Toronto, ON M4N 3M5, Canada.
Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir #3172, Toronto, ON M5S 1A8, Canada.
Burns. 2018 Feb;44(1):195-200. doi: 10.1016/j.burns.2017.07.003. Epub 2017 Aug 7.
Accurate measurement of percent total body surface area (%TBSA) burn is crucial in the management of burn patients for calculating the estimated fluid resuscitation, determining the need to transfer to a specialized burn unit and probability of mortality. %TBSA can be estimated using many methods, all of which are relatively inaccurate. Three-dimensional (3D) systems have been developed to improve %TBSA calculation and consequently optimize clinical decision-making. The objective of this study was to compare the accuracy of percent total burn surface area calculation by conventional methods against novel 3D methods.
This prospective cohort study included all acute burn patients admitted in 2016 who consented to participate. The staff burn surgeon determined the %TBSA using conventional methods. In parallel, a researcher determined 3D %TBSA using the BurnCase 3D program (RISC Software GmbH, Hagenberg, Austria). Demographic data and injury characteristics were also collected. Wilcoxon Signed Rank test was used to determine differences between each measure of %TBSA, with assessment of the influence of body mass index (BMI) and gender on accuracy.
Thirty-five patients were included in the study (6 female and 29 male). Average age was 47.5 years, with a median BMI of 26.6kg/m. %TBSA determined by BurnCase 3D program was statistically significantly different from conventional %TBSA assessment (p=0.007), with the %TBSA measured using Burn Case 3D being lower than the %TBSA determined using conventional means (Lund and Browder Diagram) by 1.3% (inter-quartile range -0.6% to 5.6%). BMI and gender did not have an impact on the estimation of the %TBSA.
The BurnCase 3D program underestimated %TBSA by 1.3%, as compared to conventional methods. Although statistically significant, this difference is not clinically significant as it has minimal impact on fluid resuscitation and on the decision to transfer a patient to a burn unit. 3D %TBSA evaluation systems are valid tools to estimate %TBSA, and should therefore be considered to improve %TBSA estimation at centers with no available experienced burn staff surgeon. Their use may ultimately prevent inappropriate transfers and allow for improved management of patients with acute burns.
准确测量烧伤患者的总体表面积百分比（%TBSA）对于计算预估液体复苏量、确定是否需要转至专业烧伤病房以及评估死亡率至关重要。%TBSA可通过多种方法进行估算，但所有这些方法都相对不够准确。三维（3D）系统已被开发出来，以改进%TBSA的计算，从而优化临床决策。本研究的目的是比较传统方法与新型3D方法在计算烧伤总面积百分比方面的准确性。
这项前瞻性队列研究纳入了2016年入院且同意参与的所有急性烧伤患者。烧伤外科医生使用传统方法确定%TBSA。与此同时，一名研究人员使用BurnCase 3D程序（奥地利哈根贝格的RISC Software GmbH公司）确定3D %TBSA。还收集了人口统计学数据和损伤特征。采用Wilcoxon符号秩检验来确定每种%TBSA测量方法之间的差异，并评估体重指数（BMI）和性别对准确性的影响。
本研究共纳入35例患者（6例女性，29例男性）。平均年龄为47.5岁，BMI中位数为26.6kg/m。BurnCase 3D程序确定的%TBSA与传统%TBSA评估在统计学上有显著差异（p = 0.007），使用Burn Case 3D测量的%TBSA比使用传统方法（伦德和布劳德图表）确定的%TBSA低1.3%（四分位间距为-0.6%至5.6%）。BMI和性别对%TBSA的估算没有影响。
与传统方法相比，BurnCase 3D程序将%TBSA低估了1.3%。尽管在统计学上有显著差异，但这种差异在临床上并不显著，因为它对液体复苏以及患者转至烧伤病房的决策影响极小。3D %TBSA评估系统是估算%TBSA的有效工具，因此对于没有经验丰富的烧伤外科医生的中心，应考虑使用该系统来改进%TBSA的估算。其使用最终可能会避免不适当的转院，并改善急性烧伤患者的管理。
