An easy-to-use, three-dimensional, computer graphics program is bringing a newlevel of accuracy, consistency and standardization to the evaluation of burnpatients, which should result in more precise treatment plans and betterevaluation of new therapies. The program will be presented October 16th at theAmerican College of Surgeons' Clinical Conferene in Chicago.
The software, developed by a team of researchers at the University of ChicagoHospitals' Burn Center, replaces the standard two-dimensional hand-drawn chartsof a patient's wounds with a morphable 3-D computer body image. Using a mouseor graphic tablet, instead of pencil on paper, the nurse or physician canadjust the diagram to match the contours of the patient's body, chart the extentand depth of the burn wounds as seen from any angle, compute the percentage oftotal-body-surface area burned, which facilitates treatment.
"The computer program is more accurate and far more consistent than the standardsystem for determining burn surface area, especially for moderate burns, whereprecise information can make the most difference," said team leader Raphael Lee,M.D., Ph.D., professor of surgery and medical director of the Burn Center at theUniversity of Chicago Hospitals.
Accurate assessment is a crucial early step in treatment planning. The size anddepth of burn wounds are the most important predictors of clinical outcome. The percentage of body surface area affected is used to calculate the patient'sfluid and nutritional needs-which can be enormous for those with severe burns. The initial assessment is also used as a benchmark to monitor a patient'sprogress and as a research tool to compare effects of different treatments.
But burn centers have long had to rely on the doctor's pencil drawings on papercharts, known as Lund-Browder diagrams, which show a standard male or femalebody, child or adult, from the front and back. Rough percentages for each bodypart are listed: for example 13 percent for the entire trunk or back, 9.5percent for one arm, 7 percent for an adult's head or 11 percent for a child's.
Reliance on these two-dimensional charts results in wide variation in assessmentof identical injuries by different professionals. Burns near the sides are lessapparent on the charts and are often underestimated, while those right in frontcan be overemphasized. And a patient's body rarely mirrors the idealized formson the standard charts.
The computer, using software originally developed for architects, allows theburn team to begin assessment on a frame, assembled from 10,000 tiny triangles,that closely resembles the patient. After keying in sex, height and weight, thephysician can manually adjust the resulting image to pull out a bigger abdomen,for example, or shrink the shoulders to match the burned patient's physique.
The burns are then drawn directly onto the rotatable 3-D computer diagram with aresolution of 0.01%. On the display, different colors indicate different wounddepths: yellow for superficial, red for deep-partial thickness or brown forfull-thickness burns. Then the program computes the percentage of body surfacearea affected as well as fluid and nutritional requirements.
Users can factor in other injuries or treatments that affect the patient'smetabolism, such as smoke inhalation or placement on a ventilator. The computerprogram automatically adjusts for these variables and then calculatesnutritional requirements. The computer is also able to zoom. Body parts can bedisplayed separately or magnified for accuracy. Wound diagrams can be updatedand compared as treatment progresses. Skin grafts, biological dressings anddonor sites (which become partial-thickness wounds), can be included in thediagram.
Studies comparing the computer with standard burn assessment found that thecomputer is much more reliable and consistent than the standard system,particularly for larger burns.
In an initial trial, using a mannequin painted with burn wounds, six nurse orphysician observers rated the wounds using Lund-Browder charts and the computer. The computer was significantly more accurate and, for large burns, produced onefifth the amount of variation between observers.
Subsequent tests with real patients in the University of Chicago Burn Unit haveconfirmed the computer's accuracy as well as the willingness of nurses andphysicians to use the program despite the time constraints of the clinicalsetting. The program requires few keyboard commands. Most functions arecontrolled by a mouse and simple pull-down menus.
"Accuracy is crucial for treating the patient," said Lee, "but consistency isessential for conducting research and communicating new findings. We hope thatby gathering better information at the beginning of treatment, we can improveour ability to evaluate outcomes and perhaps speed the development of newtherapies."
The research was sponsored by the Electric Power Research Institute, which willdistribute the software to burn centers.
Also involved in developing and testing the software were programmers David Tuch(now in graduate school at M.I.T.), Patrick Jacobsen and Gregory Kicska;burn-unit fellows Mahesh Mankani, M.D. (now in private practice in Washington,D.C.), and William Brownlee, M.D. (now at Cook County Hospital); burn-unitnurses Tina Tinnin, R.N., M.S.N., Alison Boddie, R.N., B.S.N., and AnnemarieO'Connor, R.N., B.S.N.
The above story is based on materials provided by University of Chicago Medical Center. Note: Materials may be edited for content and length.
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