Decreasing the time to re-epithelialisation by three days in acute burn care: does it matter?


Emma Lumsden1, Roy Kimble1,2,3, Kristen Storey1,3, Catherine McMillan1,3, Robert Ware2, Bronwyn Griffin1,2,3,
1Queensland Children’s Hospital, South Brisbane , Queensland , Australia
2Griffith University Faculty of Health, Gold Coast, QLD, Australia
3Centre for Children’s Health Research, South Brisbane, Queensland, Australia

Abstract

Introduction
Negative Pressure Wound Therapy (NPWT) has been introduced as an acute burn care adjunct, with application of the device at the time of initial debridement shown to decrease time to re-epithelialisation by an average of three days. However, the clinical significance of this reduction is unknown. The aim of this study was to assess the clinical significance of reducing the time to re-epithelialisation by three days. The secondary aim was the association of therapeutic morbidity to re-epithelialisation.

Methods
This was an Australian singe site, retrospective cohort study from a quaternary paediatric burns unit used registry data of patients from 2014 – 2015; before NPWT was introduced into acute burn care. The primary outcome was burn time to re-epithelialisation and scar clinic referral. Data was modelled using univariable and multivariable logistic regression models.

Results
798 patients were included. Mean time to re-epithelialisation was 20.9 days (95% CI 18.9 – 23.0) for deep dermal partial thickness burns (DPT). 207 patients (25.9%) were referred to scar clinic, 15.9% superficial dermal partial thickness (SPT), 63.3% DPT and 20.8% FT. The odds ratio of being referred to scar clinic increased by 7.6 (4.4 – 13.1; p 0.000) for each increase in burn depth. For patients with a re-epithelialisation time of 3 days less (from 21 to 18 days), the probability of scar referral for all burns reduced from 60% to 38%, days in hospital reduced by approx. a day, and follow up time reduced by one month.

Conclusion
If the use of NPWT in acute burn care reduces the time to re-epithelialisation by three days, this may have a significant clinical impact including a decreased probability of scar clinic referral, days in hospital and months follow up.

Biography

Dr Emma Lumsden is currently a Principal House Officer in general surgery at the Royal Brisbane and Women’s Hospital. She is completing her PhD with Griffith University under the supervision of Professor Roy Kimble, Professor Robert Ware and Associate Professor Bronwyn Griffin.