Retrospective analysis of photographic evaluation of burn depth

Purpose of the study: Evaluation of burn depth is an essential and difficult step that conditions surgical or non-surgical treatment. The purpose of the study is to evaluate the opportunity to diagnose burn depth only with initial photography of the burn.

Method: For all patients admitted to our burn unit between January 2002 and March 2008, we performed a retrospective analysis of burn depth based on a photographic evaluation. Blinded photos were submitted to three experienced surgeons who were asked if the burns required a graft or not. The diagnosis done by photography evaluation was then compared to initial diagnosis and treatment.

Main findings: Out of 911 patients photography analysed, the photographic evaluation was equivalent to clinical evaluation in 76% of the cases. The sensitivity and specificity of the photographic evaluation were, respectively, 0.77 and 0.75. The main evaluation errors were in intermediate burns (29.6% of errors) and were more often due to overestimation of the depth. In 75% of cases, there was a full agreement between 3 surgeons (683/911). A secondary analysis excluding electrical and chemical injuries showed an improvement of predictability.

Conclusion: Even though a photographic analysis cannot replace clinical examination, photographic evaluation may be one option to consider for an early distance diagnosis.