Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway.
Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway.
Burns. 2023 May;49(3):493-515. doi: 10.1016/j.burns.2022.05.007. Epub 2022 May 17.
The quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres.
Included articles had to meet criteria defined in a PICO (patients, interventions, comparisons, outcomes). Relevant databases were searched using a predetermined search string (November 6th 2021). Data were extracted in a standardised fashion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for test accuracy was used to assess the certainty of evidence. The QUADAS-2 tool was used to assess the risk of bias of individual studies as 'high', 'low' or 'unclear'.
A total of 412 abstracts were retrieved and of these 28 studies with a total of 6461 patients were included, all reporting %TBSA and one burn depth. All studies were cross-sectional and most of them comprising retrospectively enrolled consecutive cohort. All studies showed a low agreement between %TBSA calculations made at referring units and at burn centres. Most studies directly comparing estimations of %TBSA at referring institutions and burn centers showed a proportion of overestimations of 50% or higher. The study of burn depth showed that 55% were equal to the estimates from the burn centre. Most studies had severe study limitations and the risk of imprecision was high. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low (GRADE ⊕⊕ОО) for %TBSA and very low (GRADE ⊕ООО) for burn depth and resuscitation.
Overestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed.
烧伤治疗质量高度依赖于初始评估和护理。本系统评价的目的是调查转诊单位和烧伤中心之间对烧伤深度和%TBSA 的临床评估的一致性。
纳入的文章必须符合 PICO（患者、干预、比较、结局）标准。使用预定的搜索字符串（2021 年 11 月 6 日）在相关数据库中进行搜索。以标准化的方式提取数据。使用推荐评估、制定与评估（GRADE）方法评估测试准确性来评估证据的确定性。使用 QUADAS-2 工具评估个别研究的偏倚风险为“高”、“低”或“不清楚”。
共检索到 412 篇摘要，其中 28 项研究共纳入 6461 例患者，均报告了%TBSA 和一个烧伤深度。所有研究均为横断面研究，其中大多数为回顾性纳入连续队列。所有研究均显示转诊单位和烧伤中心的%TBSA 计算之间的一致性较低。大多数比较转诊机构和烧伤中心估计%TBSA 的直接研究表明，高估比例达到或超过 50%。烧伤深度的研究表明，有 55%的结果与烧伤中心的估计值相等。大多数研究都存在严重的研究局限性，且精度的不确定度很高。转诊中心临床估计准确性的证据整体确定性为低（GRADE ⊕⊕OO）用于%TBSA，烧伤深度和复苏为极低（GRADE ⊕OOO）。
转诊医院对%TBSA 的高估非常常见。转诊中心烧伤面积临床评估准确性的证据整体确定性为低，烧伤深度的证据整体确定性为极低。研究结果表明，烧伤界在教育和与转诊机构的同事更好地沟通方面面临重大挑战，需要高质量的研究。
