The Scar Free Foundation Centre for Children's Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK.
BMJ Open. 2018 Jun 14;8(6):e021886. doi: 10.1136/bmjopen-2018-021886.
To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care.
Proof of concept before and after study with feasibility of delivering the intervention.
Three burns services within two UK hospital trusts.
Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention.
Introduction of LF sheets and pillowcases during a 15-month period.
For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding.
131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was £-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding.
LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified.
ISRCTN82599687.
评估低摩擦（LF）床上用品在急性烧伤护理环境中对移植物丢失的影响，并检查与标准护理相比使用 LF 床上用品的可行性和成本。
在进行干预之前和之后进行概念验证，并检查提供干预措施的可行性。
英国两家医院信托的三个烧伤科。
纳入标准为年龄大于 4 周、烧伤后接受皮肤移植并住院过夜的患者。对照组是在干预前 12 个月内入院的符合条件的患者。
在 15 个月期间引入 LF 床单和枕套。
131 例患者符合 LF 组条件，90 例患者符合对照组条件。尽管 LF 组需要再次移植手术的患者比例（主要结局）减少了一半，但置信区间（CI）交叉 1（比值比（95%CI）：0.56（0.16 至 1.88））。LF 组部分移植物丢失（任何丢失）显著减少（比值比（95%CI）：0.27（0.14，0.51））。两组患者的住院时间（中位数差异（95%CI）：0（-2 至 1））无差异，估计的住院费用差异为 £-1139（-4829 至 2551）。实际问题很容易解决，而且患者使用 LF 床上用品时没有发生安全事件。
LF 床上用品在接受皮肤移植的烧伤患者中使用安全，我们已经证明了干预措施的概念验证。需要进一步进行经济建模，以确定是否值得进行适当的随机对照试验，或者是否有理由在国民保健制度中全面推广。
ISRCTN82599687。
