Mirdell Robin, Farnebo Simon, Sjöberg Folke, Tesselaar Erik
Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.
Burns. 2018 Feb;44(1):90-98. doi: 10.1016/j.burns.2017.06.010. Epub 2017 Aug 7.
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.
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 <14days or healing >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.
Sensitivity and specificity were 92.3% (95% CI: 64.0-99.8%) and 78.3% (95% CI: 69.9-85.3%) 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%, Cohen's κ=0.23.
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.
利用激光散斑对比成像（LSCI）测量儿童烫伤后前四天的微血管灌注变化，其与愈合时间及手术干预需求相关。本研究的目的是确定损伤后不同天数的LSCI在预测愈合结局方面的准确性（敏感性和特异性），以及能否通过结合早期和晚期测量来提高准确性。此外，还将LSCI的准确性与临床评估的准确性进行了比较。
对45例烫伤儿童在0 - 24小时和72 - 96小时之间使用LSCI测量灌注。在相同时间点，烧伤外科医生将烧伤评估为愈合<14天或愈合>14天/手术。使用两种不同方法为早期和晚期测量以及双重测量（DM）构建受试者操作特征（ROC）曲线。
0 - 24小时之间的敏感性和特异性分别为92.3%（95%CI：64.0 - 99.8%）和78.3%（95%CI：69.9 - 85.3%），72 - 96小时之间分别为100%（95%CI：84.6 - 100%）和90.4%（95%CI：83.8 - 94.9%），将两次测量合并为修正灌注趋势时分别为100%（95%CI：59.0 - 100%）和100%（95%CI：95.1 - 100%）。临床评估的准确性为67%，Cohen's κ = 0.23。
使用LSCI测量的损伤后72 - 96小时的烫伤灌注，对烫伤愈合结局具有高度预测性。通过纳入损伤后24小时内的早期灌注测量，预测价值可进一步提高。
