Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Glob Health Action. 2022 Dec 31;15(1):2067389. doi: 10.1080/16549716.2022.2067389.
Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage.
The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis.
Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts' image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth.
Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy.
Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.
严重烧伤需要专业护理，而轻度烧伤则应在现场处理。由于误诊较为常见，这会导致系统负担过重，由于资源短缺，其他患者得不到治疗。
本研究旨在评估南非和瑞典用于诊断、转诊和分诊急性烧伤损伤的四种决策支持工具：转诊标准、死亡率预测评分、基于图像的远程咨询和自动诊断。
研究 I 回顾性评估了南非西开普省儿科烧伤中心收治的 1165 例患者的转诊标准依从性。研究 II 通过评估现有的评分（ABSI）和使用逻辑回归评估了 372 例成人烧伤中心患者的死亡率预测。在研究 III 中，使用在线调查评估了烧伤专家使用智能手机或平板电脑进行基于图像的诊断的准确性。在研究 IV 中，开发了两种深度学习算法，使用 1105 张急性烧伤图像来识别烧伤，并对烧伤深度进行分类。
转诊标准的依从率为 93.4%，年龄和严重程度标准与患者护理相关。在成人中，ABSI 评分是死亡率的良好预测指标，影响了五分之一的患者，且与性别、烧伤面积和转诊状态有关。专家能够使用手持设备诊断烧伤面积和烧伤深度。最后，可以相对准确地开发出伤口识别器和深度分类器算法。
总之，这些发现为急性烧伤患者护理过程中使用四种工具提供了信息，通过辅助现场护理至烧伤中心的诊断、转诊和分诊，从而改善了获得最适当护理的机会，有助于减少不平等。
