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An Optical Tomography-Based Score to Assess Pediatric Hand Burns
Judith Lindert1,2, Tina Straube1,3, Beke Larsen1
1Department of Pediatric Surgery, University Hospital Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany.
Insights
Optical coherence tomography (OCT) effectively visualizes pediatric hand burns. A novel OCT burn score accurately predicts healing, aiding clinical decisions for pediatric burn patients.
Area of Science:
- Medical Imaging
- Dermatology
- Pediatric Surgery
Background:
- Pediatric hand burns present unique challenges in wound assessment and management.
- Accurate burn depth determination is crucial for predicting healing outcomes and guiding treatment strategies.
- Optical coherence tomography (OCT) offers high-resolution, non-invasive imaging of tissue microstructure.
Purpose of the Study:
- To characterize the morphologic patterns of pediatric hand burns using optical coherence tomography (OCT) and dynamic OCT (D-OCT).
- To develop and validate a novel OCT-based scoring system for assessing pediatric hand burn depth.
- To evaluate the score's ability to predict wound healing and the need for skin grafting.
Main Methods:
- Prospective examination of 67 hand burns in 48 pediatric patients (0-15 years) using OCT and D-OCT.
- Development of a scoring system based on OCT findings such as epidermal loss, dermal pattern disruption, and vascular changes.
- Retrospective calculation of score values and correlation with clinical healing outcomes and need for grafting.
Main Results:
- A specific OCT burn score (score of 4) was strongly associated with spontaneous healing without skin grafting (97% positive predictive value).
- Higher scores (5 and above) indicated deeper wounds requiring delayed healing or skin grafting, with 80% agreement in medical healing assessment.
- OCT and D-OCT provided valuable supplementary information for assessing pediatric hand burns.
Conclusions:
- OCT and D-OCT imaging are clinically useful tools for evaluating pediatric hand burns.
- The developed OCT burn score demonstrates potential in supporting clinical decision-making for burn wound management.
- Utilizing the OCT burn score may lead to improved patient outcomes and reduced hospital stays for pediatric burn patients.
Abstract:
To define the morphologic pattern of pediatric hand burns as visualized via optical coherence tomography (OCT) and dynamic OCT (D-OCT). We designed a scoring system to assess the depths of burn wounds on pediatric hands and tested this score in our cohort of children with burn injuries to the hand. Overall, 67 hand burns in 48 children (0-15 years) were prospectively examined. Scans were interpreted by two independent observers. Relevant OCT findings were surface irregularity, loss of epidermis, loss of dermal pattern (skin lines or papillary spots, loss of surface regularity and irregular vascular pattern of the plexus papillaris. Score values were calculated retrospectively. A score of 4 was associated with spontaneous healing without the need for skin grafting, with a positive predictive value of 97%. Deeper wounds with delayed healing and/or the need of skin grafting received a score of 5 or above, with an agreement of medical healing in 80% and a positive predictive value of 56%. OCT and D-OCT provide clinically useful additional information in cases of pediatric hand burns. The OCT burn score has the potential to support clinical decision making and, subsequently, improve clinical outcomes and shorten hospital stays.
