Retrospective analysis of photographic evaluation of burn depth.

Abstract

Evaluation of burn depth is an essential and difficult step that conditions surgical or non-surgical treatment. The purpose of the study is to evaluate the opportunity to diagnose burn depth only with initial photography of the burn. For all patients admitted to our burn unit between January 2002 and March 2008, we performed a retrospective analysis of burn depth based on a photographic evaluation. Blinded photos were submitted to three experienced surgeons who were asked if the burns required a graft or not. The diagnosis done by photography evaluation was then compared to initial diagnosis and treatment. Out of 911 patients photography analysed, the photographic evaluation was equivalent to clinical evaluation in 76% of the cases. The sensitivity and specificity of the photographic evaluation were, respectively, 0.77 and 0.75. The main evaluation errors were in intermediate burns (29.6% of errors) and were more often due to overestimation of the depth. In 75% of cases, there was a full agreement between 3 surgeons (683/911). A secondary analysis excluding electrical and chemical injuries showed an improvement of predictability. Even though a photographic analysis cannot replace clinical examination, photographic evaluation may be one option to consider for an early distance diagnosis.