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Three Part Question

In an [adult patient with burns] which [clinical assessment tool] gives the best diagnostic [accuracy of burn depth]?

Clinical Scenario

A 29 year old man is brought into accident and emergency suffering massive burns after having been soaked in petrol and set alight. You need to assess the depth of his burns and wonder which clinical assessment will give the best accuracy of burn depth in the emergency setting.

Search Strategy

Medline using the OVID interface 1966-06/05
[exp Burns/ or thermal injury.mp. OR thermal burn$.mp. OR exp BURNS, INHALATION/ OR exp BURNS/ OR burn$.mp. OR thermal injur$.mp. OR scald.mp. OR heat injur$.mp.] AND [depth.mp. OR degree.mp. OR thickness.mp.] AND [assessment.mp. OR measurement.mp. OR estimat$.mp.] LIMIT to human and English language.

Search Outcome

930 papers were found of which none were relevant.

Comment(s)

No quality clinical trials or studies have been done to answer this question. The most common technique for diagnosing burn depth remains the clinical assessment of an experienced burn surgeon although this is reported as having a 60-70% accuracy rate. Methods such as histological biopsies, laser doppler flowmetry and thermography have been suggested as objective methods of determining injury depth at time periods between 36 and 72h following the injury but there is no evidence regarding their use in the acute setting.

Clinical Bottom Line

There is no evidence available of any method other than clinical assessment to estimate burn depth in an adult patient with burns in the emergency setting.