Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children

Cuttle

et al. 2021

Sci Rep

Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound re-epithelialisation. Its effects on healthcare costs, however, remain poorly understood. The aim of this study was to evaluate the cost-effectiveness of NPWT from a healthcare provider perspective using evidence from the SONATA in C randomised controlled trial, in which 101 children with small-area burns were allocated to either standard care (silver-impregnated dressings) or standard care in combination with adjunctive NPWT. The primary outcome, time to re-epithelialisation, was assessed through a blinded photographic review. Resource usage and costs were prospectively recorded for each participant for up to 6 months. Incremental cost-effectiveness ratios and dominance probabilities were estimated and uncertainty quantified using bootstrap resampling. Mean costs per participant—including dressings, labour, medication, scar management, and theatre operations—were lower in the NPWT group (AUD $903.69) relative to the control group (AUD $1669.01). There was an 89% probability that NPWT was dominant, yielding both faster re-epithelialisation and lower overall costs. Findings remained robust to sensitivity analyses employing alternative theatre costs and time-to-re-epithelialisation estimates for grafted patients. In conclusion, adjunctive NPWT is likely to be a cost-effective and dominant treatment for small-area paediatric burns (ANZCTR.org.au:ACTRN12618000256279).

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Frear

Cuttle

et al. 2021

Sci Rep

“…Efforts to address the complex physiological activity of an acute burn injury, speci cally to disrupt wound progression, are increasingly visible in scienti c burns literature. The early application of negative pressure wound therapy in paediatric burn wounds has shown decreased time to re-epithelialisation, with suggested cost savings due to decreased proportions of skin grating requirements (34). Additionally, effective adherence to 20 minutes of cool running water within the rst three hours of burn injury has resulted in signi cantly reduced odds of skin grafting amongst other patient outcomes(48, 49).…”

Section: Discussionmentioning

confidence: 99%

Effects of Early, Non-Excisional Debridement in the Operating Theatre on Paediatric Burn Wound Re-Epithelialisation Time and Skin-Graft Requirement: A Retrospective Cohort Study.

Bairagi

Jones

et al. 2021

Preprint

Background: Reported advantages of early excision and grafting for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. Evidence to support this has strengthened over the last 50 years. However, a paucity of evidence supports the best option for paediatric burns and, less still, the advantages of non-excisional (mechanical) debridement. Ketamine 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 (<24hours post injury) non-excisional debridement under general anaesthesia in the operating theatre with burn wound re-epithelialisation time and skin graft requirements. Methods: Children younger than 17 years who presented with burns of five percent total body surface area or greater were included in a retrospective cohort study. Data between January 2013 to December 2019 were extracted from a state-wide paediatric burns’ registry for analysis. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirement. A propensity matched dataset based on depth and size of burn wound, was used to analyse effects of early non-excisional debridement in the operating theatre compared to control. Results: Overall, 392 children met eligibility for the study with a male over-representation of 58.2%. When propensity matched, non-excisional debridement under general anaesthesia in the operating theatre, within 24hours of injury, significantly reduced the time to re-epithelialisation (15.0 (CI: 11.00-20.00) versus 20.0 (CI:13.5 – 31.00) days) and the odds of requiring a skin graft (OR:0.319 (0.125 – 0.812).Conclusion: This study is the first to demonstrate that early, initial, non-incisional 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 in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.

“…Negative pressure wound fluid samples were collected from patients enrolled in a two‐arm, prospective, randomized controlled trial investigating the efficacy of adjunctive NPWT in the acute management of small‐area paediatric thermal burns. The trial's protocol and results have been published previously 9,10 . Briefly, children presenting with burns covering less than 5% of their total body surface area (TBSA) within 7 days of injury were randomized to either standard silver‐impregnated dressings consisting of Acticoat (Smith & Nephew, Hull, UK) with Mepitel (Mölnlycke Healthcare, Mikkeli, Finland), or these same dressings in conjunction with NPWT.…”

Section: Methodsmentioning

confidence: 99%

“…The trial's protocol and results have been published previously. 9,10 Briefly, children presenting with burns covering less than 5% of their total body surface area (TBSA) within 7 days of injury were randomized to either standard silver-impregnated…”

Section: Patient Recruitment and Sample Collectionmentioning

confidence: 99%

The modulation of the burn wound environment by negative pressure wound therapy: Insights from the proteome

Frear

Zang

Wound Repair Regeneration

et al. 2020

Self Cite

Negative pressure wound therapy has been used to promote wound healing in a variety of settings, including as an adjunct to silver‐impregnated dressings in the acute management of paediatric burns. Fluid aspirated by the negative pressure wound therapy system represents a potentially insightful research matrix for understanding the burn wound microenvironment and the intervention's biochemical mechanisms of action. The aim of this study was to characterize the proteome of wound fluid collected using negative pressure wound therapy from children with small‐area thermal burns. Samples were obtained as part of a randomized controlled trial investigating the clinical efficacy of adjunctive negative pressure wound therapy. They were compared with blister fluid specimens from paediatric burn patients matched according to demographic and injury characteristics. Protein identification and quantification were performed via liquid chromatography tandem mass spectrometry and sequential window acquisition of all theoretical mass spectra data‐independent acquisition. Proteins and biological pathways that were unique to or enriched in negative pressure wound therapy fluid samples were evaluated using principal components, partial least squares‐discriminant, and gene ontology enrichment analyses. Eight viable samples of negative pressure wound therapy fluid were collected and analyzed with eight matched blister fluid samples. A total of 502 proteins were quantitatively profiled in the negative pressure wound therapy fluid, of which 444 (88.4%) were shared with blister fluid. Several proteins exhibited significant abundance differences between fluid types, with negative pressure wound therapy fluid showing a higher abundance of matrix metalloproteinase‐9, arginase‐1, low affinity immunoglobulin gamma Fc region receptor III‐A, filamin‐A, alpha‐2‐macroglobulin, and hemoglobin subunit alpha. The results lend support to the hypothesis that negative pressure wound therapy augments wound healing through the modulation of factors involved in the inflammatory response, granulation tissue synthesis, and extracellular matrix maintenance. Data are available via ProteomeXchange with identifier PXD023168.