Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial

Frear, Cody C.; Griffin, Bronwyn; Cuttle, Leila; Kimble, Roy; McPhail, Steven

doi:10.1038/s41598-021-95893-9

Cited by 14 publications

(11 citation statements)

References 43 publications

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“…Our belief is that Huang C's study 8 did not show that negative pressure therapy could indeed draw out the deep‐down penetrated alkali. In fact, Huang C's application of NPWT to alkali wounds did not differ in mitigating oedema, intensifying perfusion, and advancing wound healing than did long‐term negative pressure therapy applied to thermal burn wounds or chronic wounds 20‐22 . Their results did not prove that an early application of NPWT can stop alkali from penetrating the burn's bed.…”

Section: Discussionmentioning

confidence: 90%

The early association of water irrigation with negative pressure wound therapy does not more efficiently reduce the depth of the alkali infiltration progress into the burn

Wang

et al. 2022

International Wound Journal

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Water irrigation is an efficacious decontaminating method for dermis exposures to corrosive agents and hence has been widely applied to treat especially alkali burns. Nevertheless, once alkali has infiltrated the deep subcutaneous tissue, washing the tissue surface with water irrigation does not attenuate the damage progress. Therefore, significant efforts have been devoted to promising strategies aimed at removing the deeply infiltrated lye. According to a recent report, the negative pressure wound therapy (NPWT) reduces the pH value of the exudate from alkali-provoked burns thus accelerating wound healing. However, it remains to be ascertained whether or not NPWT coupled with water irrigation, that is, iNPWT, more effectively hinders the alkali injury deepening. In this study, we compared the effectiveness of an early application of water irrigation with or without NPWT in preventing the progressive deepening of the alkali burn in an animal model. Our histological examination results showed no appreciable difference in tissue injury depth, dermal retention, inflammatory cell infiltration, re-epithelization, and cellular function between iNPWT and water irrigation alone treatments. Thus, our results prove that the more expensive NPWT coupled with water irrigation does not more effectively hinder the alkali's injury deepening.Hence, iNPWT use should be more cautious in clinical practice.alkali burn, NPWT, water irrigation, wound healing Key Messages• the present investigation is for the first time to explore the effectiveness of iNPWT in preventing the progressive deepening of the alkali burn in an animal model

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Section: Discussionmentioning

confidence: 90%

The early association of water irrigation with negative pressure wound therapy does not more efficiently reduce the depth of the alkali infiltration progress into the burn

Wang

et al. 2022

International Wound Journal

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“…There have been relatively few economic evaluations investigating cost-effectiveness of paediatric burn care interventions 12,14 . This has been the first study of its kind to report the cost-effectiveness of these three scar management approaches that are commonly used as part of contemporary clinical care practices among children Table 2.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of scar management post-burn: a trial-based economic evaluation of three intervention models

McPhail

Wiseman

Simons

et al. 2022

Sci Rep

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Optimal burn scar management has the potential to markedly improve the lives of children, but can require substantial healthcare resources. The study aimed to examine the cost-effectiveness of three scar management interventions: pressure garment; topical silicone gel; combined pressure garment and topical silicone gel therapy, alongside a randomised controlled trial of these interventions. Participants were children (n = 153) referred for burn scar management following grafting, spontaneous healing after acute burn injury, or reconstructive surgery. Healthcare resource use was costed from a health service perspective (6-months post-burn time-horizon). The mean total scar management cost was lowest in the topical silicone gel group ($382.87 (95% CI $337.72, $443.29)) compared to the pressure garment ($1327.02 (95% CI $1081.46, $1659.95)) and combined intervention $1605.97 ($1077.65, $2694.23)) groups. There were no significant between-group differences in Quality Adjusted Life Year estimates. There was a 70% probability that topical silicone gel dominated pressure garment therapy (was cheaper and more effective), a 29% probability that pressure garment therapy dominated combined therapy, and a 63% probability that topical silicone gel dominated combined therapy. In conclusion, topical silicone gel was the cheaper intervention, and may be favoured in the absence of clear clinical effect favouring pressure garment therapy or a combination of these management approaches.Trial registration: ACTRN12616001100482 (prospectively registered).

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“…The cost and access to an operating theatre is not always an easy accomplishment in a busy tertiary hospital. Whilst this intervention can be perceived as an early burden on hospital resources, other studies have shown that early intervention investments improve the longer term patient outcome benefits and ultimately overall cost effectiveness 53 , 54 . To better define this benefit, future work should incorporate a formalised cost effectiveness analysis, to strengthen discussions with hospital executives to consider prioritising operating theatres for this intervention.…”

Section: Discussionmentioning

confidence: 99%

Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft

Griffin

Bairagi

Jones

et al. 2021

Sci Rep

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Reported advantages of early excision for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. However, a paucity of evidence supports the best option for paediatric burns and the advantages of non-excisional (mechanical) debridement. Procedural sedation and analgesia in the emergency department is a popular alternative to debridement in operating theatres under general anaesthesia. This study aims to evaluate the association between early (< 24 h post-injury) non-excisional debridement under general anaesthesia with burn wound re-epithelialisation time and skin graft requirements. Cohort study of children younger than 17 years who presented with burns of five percent total body surface area or greater. Data from January 2013 to December 2019 were extracted from a prospectively collected state-wide paediatric burns’ registry. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirementto analyse effects of early non-excisional debridement in the operating theatre. Overall, 292 children met eligibility (males 55.5%). Early non-excisional debridement under general anaesthesia in the operating theatre, significantly reduced the time to re-epithelialisation (14 days versus 21 days, p = 0.029)) and the odds of requiring a skin graft in comparison to paediatric patients debrided in the emergency department under Ketamine sedation (OR: 6.97 (2.14–22.67), p < 0.001. This study is the first to demonstrate that early non-excisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation and analgesia in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.

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Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial

Cited by 14 publications

References 43 publications

The early association of water irrigation with negative pressure wound therapy does not more efficiently reduce the depth of the alkali infiltration progress into the burn

The early association of water irrigation with negative pressure wound therapy does not more efficiently reduce the depth of the alkali infiltration progress into the burn

Cost-effectiveness of scar management post-burn: a trial-based economic evaluation of three intervention models

Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft

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