BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany.
Institute for Medical Biometry and Informatics, University of Heidelberg, Germany.
J Burn Care Res. 2021 Sep 30;42(5):953-961. doi: 10.1093/jbcr/iraa218.
Enzymatic debridement (ED) has become a reliable tool for eschar removal. Although ED application is simple, wound bed evaluation and therapy decision post-intervention are prone to subjectivity and failure. Experience in ED might be the key, but this has not been proven yet. The aim of this study was to assess interrater reliability (IR) in post-intervention wound bed evaluation and therapy decision as well as the impact of experience. In addition, the authors introduce video assessment as a valuable tool for post-ED decision-making and education. A video-based survey was conducted among physicians with various experiences in ED. The survey involved multiple-choice and 5-point Likert scale questions about professional status, experience in ED, confidence in post-ED wound bed evaluation, and therapy decision. Subsequently, videos of 15 mixed pattern to full-thickness burns immediately after removal of the enzyme complex were demonstrated. Participants were asked for evaluation of each burn wound, including bleeding pattern and consequent therapy decision. IR ≥ 80% was considered as a consensus. Responses were stratified according to participants' experience in applying ED (<10, 10-19, 20-49, and ≥50 applications). IR was assessed by chi-square test (raw agreement [RA]; ≥80% was considered as a consensus) and by calculation of Krippendorff's alpha. In addition, expert consensus for therapy decision was compared with the actual clinical course of each shown patient. Last, participants were asked for their opinion on video as an assessment tool for post-ED wound bed evaluation, decision-making, and training. Thirty-one physicians from 11 burn centers participated in the survey. The overall consensus (raw agreement [RA] ≥ 80%) in post-ED wound bed evaluation and therapy decision was achieved in 20 and 40%, respectively. Krippendorff's alpha is given by 0.32 (95% confidence interval: 0.15, 0.49) and 0.31 (95% confidence interval: 0.16, 0.47), respectively. Subgroup analysis revealed that physicians with high experience in ED achieved significantly more consensus in post-intervention wound bed evaluation and therapy decision compared with physicians with moderate experience (60 vs 13.3%; P = .02 and 86.7 vs 33.3%; P = .04, respectively). Video analysis was considered a feasible (90.3%) and beneficial (93.5%) tool for post-intervention wound bed evaluation and therapy decision as well as useful for training purposes (100%). Reliability of wound bed evaluation and therapy decision after ED depends on the experience of the rating physician. Video analysis is deemed to be a valuable tool for ED evaluation, decision-making, and user training.
酶清创术 (ED) 已成为一种可靠的焦痂去除工具。尽管 ED 的应用简单，但干预后的创面床评估和治疗决策容易受到主观性和失败的影响。ED 方面的经验可能是关键，但这尚未得到证实。本研究旨在评估干预后创面床评估和治疗决策中的观察者间可靠性 (IR) 以及经验的影响。此外，作者还介绍了视频评估作为 ED 后决策和教育的有价值工具。对具有各种 ED 经验的医生进行了基于视频的调查。该调查涉及有关专业地位、ED 经验、对 ED 后创面床评估和治疗决策的信心的多项选择题和 5 分李克特量表问题。随后，展示了 15 例混合模式至全层烧伤，在去除酶复合物后立即进行。参与者被要求评估每个烧伤创面，包括出血模式和随后的治疗决策。IR≥80%被认为是共识。根据参与者应用 ED 的经验（<10、10-19、20-49 和≥50 次）对反应进行分层。通过卡方检验 (原始一致性 [RA]；≥80% 被认为是共识) 和计算克里普托夫的 α 来评估 IR。此外，将治疗决策的专家共识与每个展示患者的实际临床病程进行比较。最后，参与者被要求对视频作为 ED 后创面床评估、决策制定和培训的评估工具发表意见。来自 11 个烧伤中心的 31 名医生参与了调查。在 ED 后创面床评估和治疗决策中，总体共识（原始一致性 [RA]≥80%）分别达到 20%和 40%。克里普托夫的α分别为 0.32（95%置信区间：0.15，0.49）和 0.31（95%置信区间：0.16，0.47）。亚组分析显示，ED 经验丰富的医生在干预后创面床评估和治疗决策方面达成共识的比例明显高于经验中等的医生（60%比 13.3%；P=.02 和 86.7%比 33.3%；P=.04）。视频分析被认为是 ED 后创面床评估和治疗决策的一种可行（90.3%）和有益（93.5%）工具，也可用于培训目的（100%）。ED 后创面床评估和治疗决策的可靠性取决于评分医生的经验。视频分析被认为是 ED 评估、决策制定和用户培训的有价值工具。
