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Published on: May 5, 2011
Contribution of thermal imaging in determining the depth of pediatric acute burns
S Ganon1, A Guédon2, S Cassier3
1Pediatric Burn Center and Plastic Surgery, Trousseau Hospital, Paris, France.
Insights
The Flir One Thermal Imager effectively distinguishes deep pediatric burns needing grafts by measuring skin temperature differences. Early assessment with this tool shows high specificity for identifying burns healing beyond 15 days.
Area of Science:
- Pediatric Burn Management
- Medical Imaging Technology
- Wound Healing Assessment
Background:
- Accurate early assessment of pediatric burn depth is crucial for effective treatment and outcomes.
- Traditional clinical evaluations can be subjective; objective tools like thermal imagers offer potential for improved accuracy.
- Thermal imaging leverages temperature differences caused by altered dermal perfusion in deep burns to differentiate them from superficial ones.
Purpose of the Study:
- To evaluate the diagnostic validity of the Flir One thermal imager for assessing pediatric burn wound depth.
- To determine if thermal imaging can accurately differentiate between superficial and deep burns in children at an early stage.
Main Methods:
- Thermal images were captured from 40 pediatric patients at three time points post-burn (days 1-3, 4-7, 8-10).
- Temperature difference (ΔT) between the burn and healthy skin was calculated using the Flir One application.
- The study assessed the ability of ΔT to discriminate between burns healing in <15 days versus >15 days using Receiver Operating Characteristic (ROC) curve analysis.
Main Results:
- The area under the ROC curve (AUC) for thermal imaging showed increasing accuracy over time, reaching 0.968 by days 8-10 (T3).
- A ΔT threshold of -1.2°C at T3 demonstrated 100% specificity in identifying deep burns healing after 15 days.
- The device showed good performance in diagnosing burn depth, particularly for identifying those requiring longer healing times.
Conclusions:
- The Flir One Thermal Imager is a cost-effective, non-invasive tool for assessing pediatric burn depth by indirectly measuring dermal perfusion.
- The device exhibits excellent specificity for identifying deep burns in children.
- Further research is needed to improve sensitivity for earlier identification and guide decisions on skin grafting.
Background:
Early burn wound assessment is a major problem in pediatrics. It involves regular clinical evaluations, and may be helped by objective tools, such as thermal imagers. Because of the skin temperature difference between partial and full thickness burns, due to injured vascular perfusion of the dermis in the latter, it could precisely identify areas with superficial burns which could heal from controlled wound healing, and those with deep burns which would need skin graft, at an early stage. The objective of this study was to assess the validity of the Flir one thermal imager® for this purpose.
Methods:
Thermal images were obtained by a single observer three times after burn: day 1-3 (T1); day 4-7 (T2); day 8-10 (T3). ΔT (temperature difference between burned area and healthy skin) was calculated on a tablet with Flir One application. Validity was assessed by comparing ΔT obtained at each time between two groups at day 15 depending on the healing time of the burn wounds : before or after day 15. Primary outcome was the AUC (area under curve) of the ROC (Receiver operating characteristic) curve for ΔT at T1, T2 and T3, representing the ability of the Flir One Thermal Imager® to discriminate between a healing time <15 days and >15 days.
Results:
40 patients were included (13 months to 13 years old). AUC at T1 and T2 are 0.700 (95% CI: 0.649; 0.925) and 0.787 (95% CI: 0.523; 0.877), respectively. AUC at T3 is 0.968 (95% CI: 0.918; 1.00). A ΔT threshold of -1.2°C at T3 is associated with a specificity of 100% allowing to diagnose as of day 8 all the patients having deep burns which heal after 15 days.
Conclusions:
The Flir One Thermal Imager® is an inexpensive, non-invasive, and easy-to-use device. It measures indirectly but with an excellent specificity the dermis perfusion reflecting the burns depth in children. However its low sensitivity calls for additional research to allow skin grafts earlier in common practice and decrease the length of stay.
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