Energy expenditure following biodegradable dermal matrix application in severe burn injury: A pilot study
Bibliographic record
Abstract
BACKGROUND: Biodegradable temporising matrix (BTM) is a dermal substitute developed to reconstruct full thickness burns, yet the subsequent metabolic effects are unknown. This pilot study aimed to 1) measure variation in energy expenditure using indirect calorimetry (IC) in response to BTM application across the continuum of acute burns management and 2) assess accuracy of predictive energy equations commonly used in Australia in adult patients with severe burns. METHODS: Energy expenditure was measured (MEE) using IC during distinct time-periods: 'acute surgery'; 'BTM integration'; following 'skin grafting'; and 'acute recovery' and compared to predictive equations (Toronto, Schofield plus injury factor (IF), and the Ratio method from a minimum of 25 kcal/kg/day to a maximum of 40 kcal/kg/day). Agreement was assessed using Lin's concordance correlation coefficient (CCC) and Bland-Altman methods. RESULTS: Eighteen patients were included (median [Interquartile range] 44 [29-70] years; 39 % [25-56 %] total body surface area burns). MEE reported as estimated marginal means (95 % confidence intervals) for each time-period were: 'acute surgery' 2048 (1847, 2248) kcal; 'BTM integration' 2244 (2071, 2416) kcal; 'skin grafting' 2297 (2123, 2471) kcal; 'acute recovery' 2102 (1918, 2287) kcal, equating to 25 %, 37 %, 41 % and 29 % above predicted basal metabolic rate (Schofield, no injury factor), respectively (all p < 0.001). During 'acute surgery' all equations (Schofield x IF, Minimum and Maximum Ratio method), overestimated energy requirements by 24-42 % (all p < 0.001), except Toronto (-12 %, p = 0.071). Similarly, all equations overestimated energy requirements by 11-27 % throughout 'BTM integration' (all p ≤ 0.01), except Toronto (-5 %, p = 0.12). Following 'skin grafting' Schofield and Maximum Ratio equations overpredicted, while Toronto underpredicted requirements (+16 %, +21 % and -11 %, respectively, p ≤ 0.001). The Maximum Ratio overestimated and Toronto underestimated requirements during 'acute recovery' (+19 %, p = 0.04 and -9 %, p = 0.014, respectively). Average CCC (all time periods) was highest for Toronto at 0.77, with Bland-Altman plots also showing highest accuracy and reliability. CONCLUSIONS: A substantial hypermetabolic response was not observed following BTM application. While the Toronto equation most closely predicted energy requirements, considerable variability was observed, highlighting the value of IC to guide nutrition support in severe burns where nutritional needs change over time. A larger multicentre study is required to substantiate the effect of BTM application on energy expenditure.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".