The Added Benefit of Combining Laser Doppler Imaging With Clinical Evaluation in Determining the Need for Excision of Indeterminate-Depth Burn Wounds

Background Managing indeterminate-depth burn wounds remains challenging. Laser Doppler Imaging (LDI) has been validated for burn wound depth and can influence the clinical assessment. Our study investigated the value of LDI as an adjunct in determining the need for excision. Methods Seventy American Burn Association (ABA)-verified burn centers were surveyed. A controlled pre-test assessment without LDI and post-test assessment with LDI of 100 indeterminate-depth burn wounds was conducted to evaluate the influence on the clinical judgment among different health professionals. Relative risk, analysis of variance (ANOVA), paired t-test, and intention-to-treat were used for analysis. A p-value [Formula: see text] 0.05 was considered significant.  Results Among 32 burn centers, three confirmed using LDI. Six thousand grader-image interactions were analyzed. There was a significant difference in the predictive accuracy for pre-LDI and post-LDI assessments when all graders were considered (51.9% ± 7.0 vs. 72.9% ± 7.9; p < 0.0001). Post-LDI assessment added 20.9% more accuracy than the pre-LDI assessment. The post-LDI assessment was 1.4 times more likely to correctly predict the need for excision and skin-grafting than the pre-LDI assessment. All groups had an improved performance post-LDI: Group 1 (physicians), 51.9 ± 7.5 versus 76.4±5; Group 2 (nurses), 52.1 ± 6.1 versus 72.7±7.7; and Group 3 (others), 51.7 ± 9.2 versus 68.6 ± 10.1. No statistical difference was observed between groups (p = 0.92).  Conclusion LDI makes the clinical examination of indeterminate-depth burn wounds more accurate. For every five LDI evaluations performed, one assessor changed their treatment plan as a result of this imaging technique. LDI is cost-effective and increases the accuracy of determining the severity of indeterminate-depth burn wounds.