Imaging of Adult Burn Injuries
Imaging of Adult Burn Injuries
Burn injuries are a common presentation to A&E in the UK (175,000 per year) of whom 13,000
 require hospital admission. Treatment of a single burn can cost more than £63,000, and is
 ultimately dependent on the depth. Most burns are assessed by experienced clinicians within a
 few days of injury. Accurate evaluation of burn depth can be very difficult with the naked
 eye. Inaccuracy can lead to longer hospital stays, worse scarring and greater financial costs
 for the NHS. Where the burn depth (and the degree of damage to the underlying blood supply of
 the skin) is not clear by visual inspection, adjuncts may be used to aid clinical
 decision-making. Currently, the "gold standard" method of assessing skin blood flow in order
 to help burn specialists in their assessment of burn depth is Laser Doppler Imaging (LDI).
 However, LDI machines can be very large, slow to collect the images, and a single imaging
 unit costs roughly £50,000. Consequently their use is restricted to the assessment of small
 burns in compliant patients treated in specialist units. Thermal imaging (thermography) has
 evolved rapidly as a useful diagnostic tool in many medical disciplines. Previous studies
 have shown that there are significant changes in skin physiology (such as temperature and
 pigmentation) depending on the depth of the burn. Portable, high-resolution thermal cameras
 are now affordable, easy to use and can provide numerical results in under a second.
 Similarly, measurement of skin pigment levels can be achieved using portable devices such as
 the Spectrophotometric Intracutaneous analysis scope (SIAscope). The aim of this study is to
 determine if alternative measures such as thermography or SIAscope can be as useful in the
 assessment of adult burns as LDI currently is. If this study demonstrates this then these
 results will inform further studies that would investigate these alternative imaging methods
 as a diagnostic and prognostic tool in the management of burns not only in adults but also in
 children presenting to non-specialised units such as A&E.
Adult acute burn injuries are currently "read" by experienced clinicians at 2-3 days post
 injury in order to determine the necessary treatment and likely clinical outcome. Adjuncts to
 this process aim to inform the clinician of structural damage to the sub dermal vasculature.
 The current gold standard investigation is laser doppler imaging (LDI) of dermal blood flow.
 However, due to time and resource constraints, this technique is often only applied to dermal
 burns of indeterminate thickness. Thermography and the SIAscope potential offer quicker,
 quantitative analysis with equipment currently in routine medical use in other clinical
 disciplines.

 To validate its use against the current gold standard (LDI)burns of variable thicknesses will
 need to be assessed and compared with clinical outcome. Consequently, in this study, patients
 with superficial burns that would not usually require LDI will be included for comparison.
 All patients will be reassured that thermography, the SIAscope and LDI are non-invasive,
 non-harmful, quick and will not affect their burn management in any way. Images will be
 labelled by an anonymised study number and stored in on secure hospital servers according to
 the Trust's information governance policy.
Inclusion Criteria:

 -  adults burn injury within 72 hours of presentation able to undergo all three imaging
 modalities

 Exclusion Criteria:

 -  children patients not consenting