Laser Doppler perfusion imaging (LDPI) has been proven to be a useful tool in predicting the burn wound outcome in an early stage. A major disadvantage of scanning beam LDPI devices is their slow scanning speed, leading to patient discomfort and imaging artifacts. We have developed the Twente Optical Perfusion Camera (TOPCam), a whole field laser Doppler perfusion imager based on a CMOS imaging array, which is two orders of magnitude faster than scanning beam LDPI systems. In this paper the first clinical results of the TOPCam in the setting of a burn centre are presented. The paper shows perfusion images of burns of various degrees. While our system encounters problems caused by blisters, tissue necrosis, surface reflection and curvature in a manner similar to scanning beam imagers, it poses a clear advantage in terms of procedure time. Image quality in terms of dynamic range and resolution appears to be sufficient for burn diagnosis. Hence, we made important steps in overcoming the limitations of LDPI in burn diagnosis imposed by the measurement speed. © 2009 Elsevier Ltd and ISBI.
Background: In patients with burns, an early accurate diagnosis of burn depth facilitates optimal treatment. Laser Doppler imaging combined with clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of laser Doppler imaging on therapeutic decisions, clinical outcomes, and costs are unknown. Methods: A randomized controlled trial was conducted in the Dutch burn centers, including 202 patients with burns of indeterminate depth. In the standard care group, estimation of burn depth was based on clinical assessment only; in the laser Doppler imaging group, clinical assessment and laser Doppler imaging were combined. Primary outcome was time to wound healing. Furthermore, therapeutic decisions and cost-effectiveness were analyzed. Results: Mean time to wound healing was 14.3 days (95 percent CI, 12.8 to 15.9 days) in the laser Doppler imaging group and 15.5 days (95 percent CI, 13.9 to 17.2 days) in the standard care group (p = 0.258). On the day of randomization, clinicians decided significantly more often on operative or nonoperative treatment in the laser Doppler imaging group (p < 0.001), instead of postponing their treatment choice. Analyses in a subgroup of admitted patients requiring surgery showed a significant earlier decision for surgery and a shorter wound healing time in the laser Doppler imaging group. Mean total costs per patient were comparable in both groups. Conclusions: Laser Doppler imaging improved therapeutic decisions. It resulted in a shorter wound healing time in the subgroup of admitted patients requiring surgery and has the potential for cost savings of €875 per scanned patient.
Objectives: In patients with burns an early accurate diagnosis of burn depth is essential to determine optimal treatment. The combination of Laser Doppler imaging (LDI) and clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of LDI on therapeutic decisions, clinical outcomes and costs are unknown. The aim of our study was to analyse the effectiveness and cost-effectiveness of LDI in burn care. The effects of LDI on decision-making, clinical outcomes, costs, and cost-effectiveness were assessed. Methods: A randomised controlled trial was conducted in all three Dutch burn centres, including subsequent patients with burns of indeterminate depth. In the standard care (SC) group, burn depth and treatment choices were based on clinical assessment only, in the other group (LDI) clinical assessment and LDI results were combined. Primary outcome was the effect of the introduction of LDI on wound healing time. The economic evaluation was performed from a societal perspective with a bottom up approach, following the micro-costing method. Results: Mean time to wound healing from randomisation was 14.3 days in the LDI group and 15.5 days in the SC group (p= 0.258). In the subgroup of clinical patients requiring surgery earlier decision for surgery and a shorter wound healing time were observed in the LDI group (16.0 versus 19.9 days, p= 0.029). Mean total costs per patient were € 18 549 versus € 18 896 (p= 0.837). Conclusions: LDI proved to provide guidance for therapeutic decisions with a significantly shorter wound healing time in the subgroup of clinical patients requiring surgery. When time to surgery can be reduced by 2.4 days, similar to the time to decision for surgery in our study, cost savings of € 794 per scanned patient can be achieved.
