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Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision

Enzymatic debridement (ED) has become a reliable tool for eschar removal. Although ED application is simple, wound bed evaluation and therapy decision post-intervention are prone to subjectivity and failure. Experience in ED might be the key, but this has not been proven yet. The aim of this study w...

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Autores principales: Siegwart, Laura C, Böcker, Arne H, Diehm, Yannick F, Kotsougiani-Fischer, Dimitra, Erdmann, Stella, Ziegler, Benjamin, Kneser, Ulrich, Hirche, Christoph, Fischer, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483150/
https://www.ncbi.nlm.nih.gov/pubmed/33378534
http://dx.doi.org/10.1093/jbcr/iraa218
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author Siegwart, Laura C
Böcker, Arne H
Diehm, Yannick F
Kotsougiani-Fischer, Dimitra
Erdmann, Stella
Ziegler, Benjamin
Kneser, Ulrich
Hirche, Christoph
Fischer, Sebastian
author_facet Siegwart, Laura C
Böcker, Arne H
Diehm, Yannick F
Kotsougiani-Fischer, Dimitra
Erdmann, Stella
Ziegler, Benjamin
Kneser, Ulrich
Hirche, Christoph
Fischer, Sebastian
author_sort Siegwart, Laura C
collection PubMed
description Enzymatic debridement (ED) has become a reliable tool for eschar removal. Although ED application is simple, wound bed evaluation and therapy decision post-intervention are prone to subjectivity and failure. Experience in ED might be the key, but this has not been proven yet. The aim of this study was to assess interrater reliability (IR) in post-intervention wound bed evaluation and therapy decision as well as the impact of experience. In addition, the authors introduce video assessment as a valuable tool for post-ED decision-making and education. A video-based survey was conducted among physicians with various experiences in ED. The survey involved multiple-choice and 5-point Likert scale questions about professional status, experience in ED, confidence in post-ED wound bed evaluation, and therapy decision. Subsequently, videos of 15 mixed pattern to full-thickness burns immediately after removal of the enzyme complex were demonstrated. Participants were asked for evaluation of each burn wound, including bleeding pattern and consequent therapy decision. IR ≥ 80% was considered as a consensus. Responses were stratified according to participants’ experience in applying ED (<10, 10–19, 20–49, and ≥50 applications). IR was assessed by chi-square test (raw agreement [RA]; ≥80% was considered as a consensus) and by calculation of Krippendorff’s alpha. In addition, expert consensus for therapy decision was compared with the actual clinical course of each shown patient. Last, participants were asked for their opinion on video as an assessment tool for post-ED wound bed evaluation, decision-making, and training. Thirty-one physicians from 11 burn centers participated in the survey. The overall consensus (raw agreement [RA] ≥ 80%) in post-ED wound bed evaluation and therapy decision was achieved in 20 and 40%, respectively. Krippendorff’s alpha is given by 0.32 (95% confidence interval: 0.15, 0.49) and 0.31 (95% confidence interval: 0.16, 0.47), respectively. Subgroup analysis revealed that physicians with high experience in ED achieved significantly more consensus in post-intervention wound bed evaluation and therapy decision compared with physicians with moderate experience (60 vs 13.3%; P = .02 and 86.7 vs 33.3%; P = .04, respectively). Video analysis was considered a feasible (90.3%) and beneficial (93.5%) tool for post-intervention wound bed evaluation and therapy decision as well as useful for training purposes (100%). Reliability of wound bed evaluation and therapy decision after ED depends on the experience of the rating physician. Video analysis is deemed to be a valuable tool for ED evaluation, decision-making, and user training.
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spelling pubmed-84831502021-10-01 Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision Siegwart, Laura C Böcker, Arne H Diehm, Yannick F Kotsougiani-Fischer, Dimitra Erdmann, Stella Ziegler, Benjamin Kneser, Ulrich Hirche, Christoph Fischer, Sebastian J Burn Care Res Original Articles Enzymatic debridement (ED) has become a reliable tool for eschar removal. Although ED application is simple, wound bed evaluation and therapy decision post-intervention are prone to subjectivity and failure. Experience in ED might be the key, but this has not been proven yet. The aim of this study was to assess interrater reliability (IR) in post-intervention wound bed evaluation and therapy decision as well as the impact of experience. In addition, the authors introduce video assessment as a valuable tool for post-ED decision-making and education. A video-based survey was conducted among physicians with various experiences in ED. The survey involved multiple-choice and 5-point Likert scale questions about professional status, experience in ED, confidence in post-ED wound bed evaluation, and therapy decision. Subsequently, videos of 15 mixed pattern to full-thickness burns immediately after removal of the enzyme complex were demonstrated. Participants were asked for evaluation of each burn wound, including bleeding pattern and consequent therapy decision. IR ≥ 80% was considered as a consensus. Responses were stratified according to participants’ experience in applying ED (<10, 10–19, 20–49, and ≥50 applications). IR was assessed by chi-square test (raw agreement [RA]; ≥80% was considered as a consensus) and by calculation of Krippendorff’s alpha. In addition, expert consensus for therapy decision was compared with the actual clinical course of each shown patient. Last, participants were asked for their opinion on video as an assessment tool for post-ED wound bed evaluation, decision-making, and training. Thirty-one physicians from 11 burn centers participated in the survey. The overall consensus (raw agreement [RA] ≥ 80%) in post-ED wound bed evaluation and therapy decision was achieved in 20 and 40%, respectively. Krippendorff’s alpha is given by 0.32 (95% confidence interval: 0.15, 0.49) and 0.31 (95% confidence interval: 0.16, 0.47), respectively. Subgroup analysis revealed that physicians with high experience in ED achieved significantly more consensus in post-intervention wound bed evaluation and therapy decision compared with physicians with moderate experience (60 vs 13.3%; P = .02 and 86.7 vs 33.3%; P = .04, respectively). Video analysis was considered a feasible (90.3%) and beneficial (93.5%) tool for post-intervention wound bed evaluation and therapy decision as well as useful for training purposes (100%). Reliability of wound bed evaluation and therapy decision after ED depends on the experience of the rating physician. Video analysis is deemed to be a valuable tool for ED evaluation, decision-making, and user training. Oxford University Press 2020-12-30 /pmc/articles/PMC8483150/ /pubmed/33378534 http://dx.doi.org/10.1093/jbcr/iraa218 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the American Burn Association. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Siegwart, Laura C
Böcker, Arne H
Diehm, Yannick F
Kotsougiani-Fischer, Dimitra
Erdmann, Stella
Ziegler, Benjamin
Kneser, Ulrich
Hirche, Christoph
Fischer, Sebastian
Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision
title Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision
title_full Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision
title_fullStr Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision
title_full_unstemmed Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision
title_short Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision
title_sort enzymatic debridement for burn wound care: interrater reliability and impact of experience in post-intervention therapy decision
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483150/
https://www.ncbi.nlm.nih.gov/pubmed/33378534
http://dx.doi.org/10.1093/jbcr/iraa218
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