527 Bromelain Debridement’s Effect on the Surgeon’s Burn Wound Depth Assessment
Notice bibliographique
Résumé
Abstract Introduction Most surgeons rely on visual inspection to determine the healing capacity of burn wounds. For indeterminate wounds, this can create delays in care on one hand or unnecessary surgery on the other. We report herein the effect of bromelain debridement (BD) on the assessment of indeterminate wounds. Methods Three surgeons reviewed 92 images (46 pre- and 46 post-BD treatment) of burn wounds from 31 patients who were previously treated with BD as part of the NEXT study (Mediwound). The images were labeled pre or post BD treatment but were otherwise deidentified and placed in random order. Each surgeon was asked to estimate wound depth defined as the percent superficial partial (SPT), deep partial (DPT), and full thickness (FT), time to heal (< 1, 1, 2, or ≥3 weeks), and if grafting would be required. Intra class correlation (ICC) was used to assess inter-rater agreement for SPT, DPT and FT ratings as well as time to heal. P < 0.05 was considered significant. Results Most patients were male (64.5%), white (68.6%), and young (mean 37 years of age). Most suffered flame burns (64.5%); the median burn size was 8.3%. Twenty-five patients had one wound and six had two or more wounds treated with BD. Grafting was performed on 20 wounds on a total of 11 patients. Wounds not grafted healed significantly faster than those grafted (2 [IQR 1-3.25] vs. 4 [IQR 2.25-5] weeks; p < 0.001) with a significantly lower Modified Vancouver Scar Scale (MVSS) score (3 [range 0 to 10] vs. 5 [range 1-14]; p = 0.024). Interrater agreement increased significantly post-BD treatment for SPT and DPT assessments compared to pre-BD treatment (ICC 0.864 and 0.876 respectively, p < 0.001 compared to -0.052 and -0.689 respectively, p = 0.567 and 0.973). BD treatment also improved the interrater agreement when estimating time to heal pre- and post-BD treatment (ICC = 0.539 pre-BD vs 0.652 post). BD treatment did not improve the agreement on the need for skin grafting which remained slight pre- and post-BD treatment (ICC = 0.213 and 0.227, p = 0.012 and 0.008). Conclusions BD treatment significantly increased the agreement between surgeons on estimating partial thickness wounds and time to heal. However, it did not clarify need for a skin graft. As the latter is largely subjective and based on several factors, we postulate a larger homogenous rater pool may be needed to assess whether BD treatment improves surgeons’ ability to estimate the need for skin grafting. Applicability of Research to Practice BD may increase the ability of surgeons to estimate wound depth and time to heal. More research is needed to determine if it effects surgical decision making. Funding for the Study N/A
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».