burns 40 (2014) 1813–1821
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Burn surface area calculation instead of burn size estimation: Our opinion
Authors’ contribution
Dear Editor,
L.P.K. has written most parts of the manuscript. All authors helped to draft the manuscript. All authors read and approved the final version of the manuscript.
With great interest we have read the paper published by Harish et al. [1]. The authors have discussed the factor burn surface area estimation and the potential impact of inaccuracies in burn size assessment on burn care and on referral to specialised burn units. Furthermore, they stated that there is tendency for significant overestimation throughout the entire TBSA spectrum in referring centres. We partly agree with this paper and its statements, because we think that there is the general tendency to overestimate burn size [2–7] and that a correct evaluation of these factors is of utmost importance for initiating the appropriate treatment [7], but in contrast to them we think that inaccurate burn size estimation is not only a question of experience and teaching and thereby of referral centres or burn centres, but of using the right techniques. We think that in future there is need for objective burn size calculation instead of subjective estimation. Therefore, we think there is a need for new techniques like computer-aided systems [4–6], because nowadays, there are different techniques available in order to improve burn size assessment and thereby to improve burn care. We can use so-called three-dimensional technologies for assessing TBSA in different ways: First, wounds can be marked manually on a virtual patient model, which is the fastest, but depends on the accuracy of the person performing it. Second, the superimposition of digital images can support the user, who ideally just traces the wounds on the picture and by doing so marks the areas on the virtual model. Last but not least, it is also possible to use false colour pictures, generated by burn depth determination devices (e.g. Laser-Doppler-Imaging), which are superimposed automatically onto 3D models [4–6]. Which of these techniques will become standard of care is still under discussion, but in conclusion, we think that improving burn surface area calculations by using more objective methods instead of subjective assessments, will be the important step in order to improve future burn care.
Competing interests All authors declare that there is no conflict of interest.
references
[1] Harish V, Raymond AP, Issler AC, Lajevardi SS, Chang LY, Maitz PK, Kennedy P, et al. Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: An audit of 698 patients. Burns 2014. http://dx.doi.org/10.1016/ j.burns.2014.05.005. Jun 24. pii: S0305-4179(14)00170-3 http:// www.ncbi.nlm.nih.gov/pubmed/24972983 [Epub ahead of print]. [2] Martin NAJ, Lundy JB, Rickard RF. Lack of precision of burn surface area calculation by UK Armed Forces medical personnel. Burns 2014;40(March (2)):246–50. [3] Rickard RF, Martin NA, Lundy JB. Imprecision in TBSA calculation. Burns 2014;40(February (1)):172–3. [4] Giretzlehner M, Dirnberger J, Owen R, Haller HL, Lumenta DB, Kamolz LP. The determination of total burn surface area: how big is the difference? Burns 2014;40(February (1)):170–1. [5] Kamolz LP, Parvizi D, Giretzlehner M, Lumenta DB. Burn surface area calculation: what do we need in future. Burns 2014;40(February (1)):171–2. [6] Giretzlehner M, Dirnberger J, Owen R, Haller HL, Lumenta DB, Kamolz LP. The determination of total burn surface area: how much difference? Burns 2013;39(6):1107–13. [7] Parvizi D, Kamolz LP, Giretzlehner M, Haller HL, Trop M, Selig H, et al. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things we should keep in mind. Burns 2014;40(March (2)):241–5.
Lars-Peter Kamolz* Paul Wurzer Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria Michael Giretzlehner Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria Daryousch Parvizi David B. Lumenta Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
1814
burns 40 (2014) 1813–1821
*Corresponding author at: Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. Tel.: +43 6765045004 E-mail address: [email protected] (L.-P. Kamolz), [email protected] (P. Wurzer), [email protected] (M. Giretzlehner), [email protected] (D. Parvizi), [email protected] (D.-B. Lumenta) http://dx.doi.org/10.1016/j.burns.2014.06.020 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Varun Harisha,b,c,* Andrew P. Raymonda,b Andrea C. Isslera Sepehr S. Lajevardia Ling-Yun Changa Peter K.M. Maitza,b,c Peter Kennedya a Burns Unit, Concord Repatriation General Hospital, Sydney, Australia b ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia c University of Sydney, Sydney, Australia *Corresponding author at: Burns Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia. Tel.: +61 2 9767 7775; fax: +61 2 9767 5834 E-mail address: [email protected] (V. Harish)
Reply to Letter to the Editor Response to Letter to the Editor: ‘Burn surface area calculation instead of burn size estimation: Our opinion’
http://dx.doi.org/10.1016/j.burns.2014.08.006 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Dear Editor, We thank Kamolz et al. for their valuable comments regarding our paper ‘Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: an audit of 698 patients’ [1]. We agree with Kamolz et al. in that accurately estimating burn size comes with education, clinical experience, and using the most appropriate modes of assessment. The letter by Kamolz et al. highlights once more the important conclusion from our paper: inaccuracies in burn size assessment are widely prevalent and have the potential to result in suboptimal treatment and inappropriate referral to specialised Burn Units. The future of estimation of burn size care and therefore the future of burn care certainly lies in objective means of determining total body surface area burned. As noted by Kamolz et al., which of these techniques will become the standard of care remains a matter of debate but we look forward to monitoring the accuracy of currently available and future technologies.
Conflict of interest The authors declare that there is no source of financial or other support, or any financial or professional relationships which may pose a competing interest.
reference
[1] Harish V, Raymond AP, Issler AC, Lajevardi SS, Chang L-Y, Maitz PKM, et al. Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: an audit of 698 patients. Burns 2014.
Letter to the Editor Home hydrotherapy in the postoperative rehabilitation phase of the burn patients
Sir, We recently read with great interest the article entitled ‘‘Hydrotherapy in burn care: A survey of hydrotherapy practices in the UK and Ireland and literature review’’ by Langschmidt et al. [1]. The authors have made a wonderful attempt to objectively evaluate a neglected aspect of burn care. The survey has been excellently designed and the subsequent thorough literature review/discussion provides a comprehensive evidence-base on this important aspect of burn care. There is one more practice-parameter of interest which we feel has not been addressed by the survey. If it could have been addressed by the survey, it would have further enhanced the quality and practical utility of this article. This missing variable is the phase of burn care where the hydrotherapy is instituted. Whether preoperatively or post-operatively after wound coverage with skin grafts. And for how long in terms of the total days–weeks of the total duration of the therapy. When to start it exactly and when to discontinue. The developing countries like ours (Pakistan) have a considerably higher burden of burns and our less than optimal health care facilities make their management further challenging. Owing to the resource constraints, we often follow management practices consistent with our local circumstances [2–4]. Anecdotally we routinely employ ‘‘home hydrotherapy’’ for all burn patients in their immediate rehabilitation period
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Burn surface area calculation instead of burn size estimation: Our opinion
Authors’ contribution
Dear Editor,
L.P.K. has written most parts of the manuscript. All authors helped to draft the manuscript. All authors read and approved the final version of the manuscript.
With great interest we have read the paper published by Harish et al. [1]. The authors have discussed the factor burn surface area estimation and the potential impact of inaccuracies in burn size assessment on burn care and on referral to specialised burn units. Furthermore, they stated that there is tendency for significant overestimation throughout the entire TBSA spectrum in referring centres. We partly agree with this paper and its statements, because we think that there is the general tendency to overestimate burn size [2–7] and that a correct evaluation of these factors is of utmost importance for initiating the appropriate treatment [7], but in contrast to them we think that inaccurate burn size estimation is not only a question of experience and teaching and thereby of referral centres or burn centres, but of using the right techniques. We think that in future there is need for objective burn size calculation instead of subjective estimation. Therefore, we think there is a need for new techniques like computer-aided systems [4–6], because nowadays, there are different techniques available in order to improve burn size assessment and thereby to improve burn care. We can use so-called three-dimensional technologies for assessing TBSA in different ways: First, wounds can be marked manually on a virtual patient model, which is the fastest, but depends on the accuracy of the person performing it. Second, the superimposition of digital images can support the user, who ideally just traces the wounds on the picture and by doing so marks the areas on the virtual model. Last but not least, it is also possible to use false colour pictures, generated by burn depth determination devices (e.g. Laser-Doppler-Imaging), which are superimposed automatically onto 3D models [4–6]. Which of these techniques will become standard of care is still under discussion, but in conclusion, we think that improving burn surface area calculations by using more objective methods instead of subjective assessments, will be the important step in order to improve future burn care.
Competing interests All authors declare that there is no conflict of interest.
references
[1] Harish V, Raymond AP, Issler AC, Lajevardi SS, Chang LY, Maitz PK, Kennedy P, et al. Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: An audit of 698 patients. Burns 2014. http://dx.doi.org/10.1016/ j.burns.2014.05.005. Jun 24. pii: S0305-4179(14)00170-3 http:// www.ncbi.nlm.nih.gov/pubmed/24972983 [Epub ahead of print]. [2] Martin NAJ, Lundy JB, Rickard RF. Lack of precision of burn surface area calculation by UK Armed Forces medical personnel. Burns 2014;40(March (2)):246–50. [3] Rickard RF, Martin NA, Lundy JB. Imprecision in TBSA calculation. Burns 2014;40(February (1)):172–3. [4] Giretzlehner M, Dirnberger J, Owen R, Haller HL, Lumenta DB, Kamolz LP. The determination of total burn surface area: how big is the difference? Burns 2014;40(February (1)):170–1. [5] Kamolz LP, Parvizi D, Giretzlehner M, Lumenta DB. Burn surface area calculation: what do we need in future. Burns 2014;40(February (1)):171–2. [6] Giretzlehner M, Dirnberger J, Owen R, Haller HL, Lumenta DB, Kamolz LP. The determination of total burn surface area: how much difference? Burns 2013;39(6):1107–13. [7] Parvizi D, Kamolz LP, Giretzlehner M, Haller HL, Trop M, Selig H, et al. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things we should keep in mind. Burns 2014;40(March (2)):241–5.
Lars-Peter Kamolz* Paul Wurzer Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria Michael Giretzlehner Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria Daryousch Parvizi David B. Lumenta Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
1814
burns 40 (2014) 1813–1821
*Corresponding author at: Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. Tel.: +43 6765045004 E-mail address: [email protected] (L.-P. Kamolz), [email protected] (P. Wurzer), [email protected] (M. Giretzlehner), [email protected] (D. Parvizi), [email protected] (D.-B. Lumenta) http://dx.doi.org/10.1016/j.burns.2014.06.020 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Varun Harisha,b,c,* Andrew P. Raymonda,b Andrea C. Isslera Sepehr S. Lajevardia Ling-Yun Changa Peter K.M. Maitza,b,c Peter Kennedya a Burns Unit, Concord Repatriation General Hospital, Sydney, Australia b ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia c University of Sydney, Sydney, Australia *Corresponding author at: Burns Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia. Tel.: +61 2 9767 7775; fax: +61 2 9767 5834 E-mail address: [email protected] (V. Harish)
Reply to Letter to the Editor Response to Letter to the Editor: ‘Burn surface area calculation instead of burn size estimation: Our opinion’
http://dx.doi.org/10.1016/j.burns.2014.08.006 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Dear Editor, We thank Kamolz et al. for their valuable comments regarding our paper ‘Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: an audit of 698 patients’ [1]. We agree with Kamolz et al. in that accurately estimating burn size comes with education, clinical experience, and using the most appropriate modes of assessment. The letter by Kamolz et al. highlights once more the important conclusion from our paper: inaccuracies in burn size assessment are widely prevalent and have the potential to result in suboptimal treatment and inappropriate referral to specialised Burn Units. The future of estimation of burn size care and therefore the future of burn care certainly lies in objective means of determining total body surface area burned. As noted by Kamolz et al., which of these techniques will become the standard of care remains a matter of debate but we look forward to monitoring the accuracy of currently available and future technologies.
Conflict of interest The authors declare that there is no source of financial or other support, or any financial or professional relationships which may pose a competing interest.
reference
[1] Harish V, Raymond AP, Issler AC, Lajevardi SS, Chang L-Y, Maitz PKM, et al. Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: an audit of 698 patients. Burns 2014.
Letter to the Editor Home hydrotherapy in the postoperative rehabilitation phase of the burn patients
Sir, We recently read with great interest the article entitled ‘‘Hydrotherapy in burn care: A survey of hydrotherapy practices in the UK and Ireland and literature review’’ by Langschmidt et al. [1]. The authors have made a wonderful attempt to objectively evaluate a neglected aspect of burn care. The survey has been excellently designed and the subsequent thorough literature review/discussion provides a comprehensive evidence-base on this important aspect of burn care. There is one more practice-parameter of interest which we feel has not been addressed by the survey. If it could have been addressed by the survey, it would have further enhanced the quality and practical utility of this article. This missing variable is the phase of burn care where the hydrotherapy is instituted. Whether preoperatively or post-operatively after wound coverage with skin grafts. And for how long in terms of the total days–weeks of the total duration of the therapy. When to start it exactly and when to discontinue. The developing countries like ours (Pakistan) have a considerably higher burden of burns and our less than optimal health care facilities make their management further challenging. Owing to the resource constraints, we often follow management practices consistent with our local circumstances [2–4]. Anecdotally we routinely employ ‘‘home hydrotherapy’’ for all burn patients in their immediate rehabilitation period
