One Burn One Standard

oneburnonestandard

www.oneburnonestandard.org

Progress is immanent…….

From wheel to Higg`s bosom

Information media has changed

and got accesible for all of us….

From Papyrus Ebers (~1514 BC) to modern journals ……

In spite of this evidence based burn

treatment is rare..

“Whilst the numbers of RCTs are increasing there is little evidence that burn care is an evidence-based practice.” Childs, C. (1998). Is there an evidence-based practice for burns? Burns : journal of the International Society for Burn Injuries, 24(1), 29–33.

“The burn care literature suffers from a relative shortage of high-quality evidence. More randomized controlled trials are warranted.” Al-Benna, S., Alzoubaidi, D., & Al-Ajam, Y. (2010). Evidence-based burn care--An assessment of the methodological quality of research published in burn care journals from 1982 to 2008. Burns : journal of the International Society for Burn Injuries, 36(8), 1190–5.

“There currently exists a need for evidence-based information and tools in burns care.” Munn, Z., Kavanagh, S., Lockwood, C., Pearson, A., & Wood, F. (2013). The development of an evidence based resource for burns care. Burns : journal of the International Society for Burn Injuries, 39(4), 577–82.

There are Problems with RCTs,

but there are underlying problems…

How do we calculate TBSA??

Accuracy of the Lund Browder

Chart

Inter rater reliability of Lund

Browder chart Table 1 – %HSA/BSA (ratio of hand surface area to body

surface area) dataa in various studies

Study

%HSA/BSA

Du Bois and Du Bois [5] Berkow [6]

Lund and Browder [7]

Livingston and Lee [8] BMI <29

BMI 30–39 BMI >40

Tikuisis et al. [9] Men

Women

1.85–3.5

2.25 2.50

2.00 1.85 1.30

2.975 2.31

BMI: body mass index. a The data are single-handed.

Other shortcomings of the

Lund Browder Chart:

Difference in TBSA of 17%

What happened in the lateral body parts?

Did the models fit?

Progress brought electronic calculators

(with the same errors?)

2D systems:

3D methods:

3D methods shortcomings:

Model adaptation?

Can standard models be used?

Can patient be classified as fitting to a model

Which algorithm can be used for the choice of a model?

Individual models or model libraries?

All methods:

Technical format? HL7

DEC Object File Format

CAD

BRL-CAD Database Format

PythonCAD File Format

DICOM

Database format?

We need standards to

create comparability

and evidence!

Or let‘s talk about burn degrees

How do we classify our burn depth?

When do we classify?

Burn edema

Catecholamines

Pressure?

Do we correct wrong classifications

afterwards?

Burn depth classification What will heal sponaneously (within two or three weeks?)

Clinical signs

Observation

Course of healing

„Necessity“ of Surgery

Burn depth objectivation

LDI

BurnCam

Laser Speckle

Indocyanin flouroskopy

????????????

Or let‘s talk about surgery!

Necrosectomy:

Early (before day 3?)

What is debridement?

Cleaning wounds with water?

Removong blisters?

Cleaning wounds with sharp towel

Cleaning wounds with iron brush

Tangential excision with humby knife

??????

So, how to create comparability

of data?

The recent development of software for supporting burn treatment has induced a rethinking of current medical documentation processes of burns

– missing medical evidence in this field of medicine showed an increasing urgency to deal with this topic

It needs international standards for burns registration

It needs international standards for burns documentation in electronic media

ABA 2013 Palm Springs

Organization for Delivery of Burn Care (ODBC) James Jeng:

decided to form a task force to establish an international standard for electronic documentation of burns.

○ Meeting of people, busy in burns documentation (Surgeons, IT specialists..)

○ Plenary session : what we need to create an international data standard

○ Wiki as the way to develop this effort to an open, international level

Further schedule:

Creation of a collabourative Wiki

www.oneburnonestandard.org

Cooperative work on creation of standards

Consensus meeting

Implementing the standards in software

Evaluation of the standards

Demonstrating the usability in a multicenter

study

The task force

M. Giretzlehner, Johannes, Kepler Universitat Linz, UAR, RISC Software GmbH,

Medizin-Informatik, Hagenberg, Austria,

J. C. Jeng, MedStar Washington Hospital Center,

Catholic University of America, Washington, WA, United States

L. D. Faucher, University of Wisconsin, Madison, WI, United States

M. A. Pressman, Arizona Burn Center, Phoenix, AZ, United States,

J. Salinas, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX,

United States,

P. M. Coghlan, Royal Adelaide Hospital, Adelaide, Australia

S. E. Morris, University of Utah, Salt Lake City, UT, United States

H. L. Haller, Trauma Hospital UKH Linz, Linz, Austria,

Where are you?

One Burn One Standard

www.oneburnonestandard.org