Centre for Academic Child Health, University of Bristol, UK; Children's Burns Research Centre, Bristol Royal Hospital for Children, Bristol, UK.
Children's Burns Research Centre, Bristol Royal Hospital for Children, Bristol, UK.
Burns. 2020 Nov;46(7):1487-1497. doi: 10.1016/j.burns.2020.03.009. Epub 2020 Apr 24.
Burn wound infections result in delayed healing and increased pain, scarring, sepsis risk and healthcare costs. Clinical decision making about burn wound infection should be supported by evidence syntheses. Validity of evidence from systematic reviews may be reduced if definitions of burn wound infectionvary between trials. This review aimed to determine whether burn wound infectionis defined, and whether there is variation in the indicators used to define burn wound infectionacross studies testing interventions for patients with burns.
Searches were carried out in four databases (Ovid Medline, Ovid Embase, Cinahl, Cochrane Register of Trials) to identify studies evaluating interventions for patients with burns and reporting a burn wound infection outcome. Pre-defined inclusion and exclusion criteria were systematically applied to select relevant studies. Data were systematically extracted and reported narratively.
2056 studies were identified, of which 72 met the inclusion criteria, comprising 71 unique datasets. 52.1% of studies were randomised controlled trials. Twenty-eight (38.0%) studies reporting a burn wound infection outcome did not report how they had defined it. In the methods of included studies, 59 studies (83.1%) reported that they planned to measure burn wound infection as an outcome. Of these, 44 studies (74.6%) described how they had defined burn wound infection; 6 studies (13.6%) reported use of a previously developed consensus-informed definition of burn wound infection, and 41 studies (69.5%) described the specific indicators used to define it. Studies used between one (11 studies; 26.8%) and nine indicators (2 studies; 4.9%) to define burn wound infection (median = 3, inter-quartile range = 2). The most commonly used indicator was presence of bacteria in the wound (61.0% of studies). Only 13 studies (31.7%) defined burn wound infection using the same indicators as at least one other study.
Within intervention studies reporting burn wound infection outcomes, a definition of this outcome is commonly not provided, or it varies between studies. This will prevent evidence synthesis to identify effective treatments for patients with burn injuries. Since there is no objective method for assessing burn wound infection, expert consensus is needed to agree a minimum set of indicators (Core Indicator Set) reported in all trials reporting burn wound infection as an outcome.
烧伤创面感染会导致愈合延迟、疼痛加剧、瘢痕形成、败血症风险增加和医疗保健费用增加。关于烧伤创面感染的临床决策应该以证据综合为依据。如果试验之间烧伤创面感染的定义不同，系统评价的证据有效性可能会降低。本研究旨在确定是否定义了烧伤创面感染，以及在评估烧伤患者干预措施的研究中，用于定义烧伤创面感染的指标是否存在差异。
在四个数据库（Ovid Medline、Ovid Embase、CinaHL、Cochrane 临床试验注册中心）中进行检索，以确定评估烧伤患者干预措施并报告烧伤创面感染结果的研究。系统地应用预定义的纳入和排除标准来选择相关研究。系统地提取和报告数据。
共确定了 2056 项研究，其中 72 项符合纳入标准，包括 71 个独特数据集。52.1%的研究为随机对照试验。28 项（38.0%）报告烧伤创面感染结果的研究未报告其定义方法。在纳入研究的方法中，59 项研究（83.1%）报告计划将烧伤创面感染作为结果进行测量。其中，44 项研究（74.6%）描述了他们如何定义烧伤创面感染；6 项研究（13.6%）报告使用了先前制定的烧伤创面感染共识指导定义，41 项研究（69.5%）描述了用于定义烧伤创面感染的具体指标。研究使用了 1 个（11 项研究；26.8%）到 9 个指标（2 项研究；4.9%）来定义烧伤创面感染（中位数=3，四分位距=2）。最常用的指标是创面存在细菌（61.0%的研究）。只有 13 项研究（31.7%）使用与至少一项其他研究相同的指标定义烧伤创面感染。
在报告烧伤创面感染结果的干预研究中，通常未提供该结果的定义，或者在研究之间存在差异。这将阻止为烧伤患者确定有效治疗方法的证据综合。由于没有评估烧伤创面感染的客观方法，因此需要专家共识来商定作为报告烧伤创面感染结果的所有试验都要报告的最小指标集（核心指标集）。
