moorLDI2-BI

Burn Assessment

*STOP PRESS* Moor Instruments is delighted to have received notice from the National Institute for Health and Clinical Excellence (NICE) supporting the implementation of moorLDI2-BI for clinical burn assessment. For full information about this guidance decision, please refer to the NICE website. On Monday 23 May 2011 12:30 – 13:30 there will be a webinar hosted by NICE discussing putting this guidance into practice. Please book your space through the NICE website!

Introduction

The moorLDI2-BI™ (moorLDI2™ Burns Imager) uses the laser Doppler technique of skin blood flow measurement to predict the healing potential (HP) of a burn wound.

Clinical studies have shown efficacy of laser Doppler imaging for burn assessments, including an international, multi-centre trial to define important ranges: burn wounds heal within 14 days where there is high LD blood flow, between days 14 and 21 with ‘medium’ blood flow, and take longer than 21 days where there is low LD blood flow (the latter usually indicating that surgery is required).

With the introduction of moorLDI2-BI™ laser Doppler imager different regions of a mixed depth burn can be mapped in a single image. A scan includes thousands of individual laser Doppler measurements and these are displayed as a colour coded image alongside a corresponding colour photograph. .

Accuracy of moorLDI2-BI™

Since the development of the moorLDI™, a number of publications have shown the higher accuracy achieved with the aid of LDI in burn depth and healing potential assessment.

Niazi et al (1993) first evaluated the technique of burn depth measurement using LDI. They found that the most common error (4/17 cases) was overestimation of burn depth by clinical assessment alone. In two cases burn depth was underestimated. By comparison, with the aid of LDI, assessments were correct in all cases (4 superficial dermal and 13 deep-dermal or full thickness burns).

Pape et al. (2001) published an audit of the use of LDI in the assessment of burn depth. They reported that the LDI enabled accurate assessment of burn depth in 97% of burns, compared with 73% for clinical assessment alone. These findings were similar to those reported by Monstrey et al. (2001, Abstract) who reported accuracy of 93.3–96.6% with LDI compared to 61–67% for clinical evaluation alone, when LDI scanning was performed at day 3 and day 5 post-burn, respectively.

Jeng et al. (2001) stated that use of the LDI enabled them to make earlier and more objective determination of the need to excise and graft burns. In a separate study, Pape and Byrne (2001) presented evidence that the use of LDI avoided unnecessary surgery, resulting in a reduction of both costs and workload.

In 2002 Holland et al. also reported that the moorLDI™ was an accurate method for the prediction of burn wound healing in children (Holland et al, 2002). This study included 57 children with a mean age of 1 year and 10 months. The sensitivity and the specificity of the moorLDI™ were higher than clinical evaluation:

Sensitivity: with LDI – 0.90; clinical evaluation – 0.66. Specificity: with LDI – 0.96; clinical evaluation – 0.71.

Equipment required

The moorLDI2-BI™ system includes the moorLDI2-BI™ scan head, scan controller, touch-screen panel PC, all mounted on a mobile clinical stand that can be used in the ward, operating theatre or consulting / treatment room. Full installation, clinical training and certification are included together with a premium service contract.

Summary

The moorLDI2-BI™ can help the burn surgeon by indicating the healing potential (HP) of burn wounds. The current clinical practice is to report burn depth; for example the Latarjet classification: first-degree, superficial second-degree, deep second-degree and third-degree. We have introduced the term Healing Potential (HP) when interpreting moorLDI2-BI™ burn scan images to indicate the expected healing time, a parameter more directly relevant to the patient and their clinical management..

An international, multi-centre study was carried out using the moorLDI2-BI™ to analyse the ranges of blood flow that correlated with healing within 3 specified time-periods; by post-burn day 14, between post-burn day 14 and 21, and greater than 21 days.

The HP categories are: HP 14, the wound has the potential to heal within 14 days of the burn injury; HP 14-21, the wound has the potential to heal between 14 to 21 days post burn; HP >21, the wound will take longer than 21 days to heal.

The actual healing time of the wound will, however, depend upon other factors that can prolong wound healing (e.g. wound infection or use of inotropes). Thus, the moorLDI2-BI™ can provide an indication of the potential of the wound to heal but the actual healing time is dependent upon other clinical, biological and environmental factors.

Use of the moorLDI2-BI™ has been shown to avoid unnecessary surgery in patients with superficial dermal wounds and promote earlier surgery for deep dermal wounds.