93 Optical Coherence Tomography: A New Imaging Technique for Burn Injuries

Abstract Introduction Accurate assessment of burn depth and healing time remains elusive. As a result, some patients may wait weeks, through painful wound care only to have surgery. Others may have early surgery on wounds that may have healed with a good outcome. Expert opinion remains the most common method of wound evaluation. We sought to evaluate if Optical Coherence Tomography (OCT) with Microangiography (OMAG) can predict burn wound healing. Methods We prospectively enrolled a cohort of 17 burned subjects whose attending physician initially evaluated the depth of the wound as indeterminate. Burn wounds were scanned on enrollment and weekly, until healed or grafted, using a clinical prototype swept source OCT with OMAG capability. Wounds were also assessed by the attending physician for depth of injury and healing time. Wounds were photographed at the time of each scan. OCT and OMAG scans were then used to quantitatively determine blood vessel depth and density within the wound. Univariate regression with clustering and panel effects evaluated the association with healing time. Photographs and scans of each wound from all time points were evaluated by 5 blinded assessors (four surgeons and an OCT engineer) for time to wound healing. Kappa was used to measure the interrater reliability between evaluators. Results The mean patient age was 46 years with a mean burn size of 10% body surface area. Fourteen patients ultimately healed their wounds. Three patients underwent excision and grafting. There was no significant association between vessel depth or density and healing time (Table). Similarly, vessel depth was not predictive of the need for surgery. However, vessel density £ 0.255 perfectly predicted the need for surgery. There was no agreement between evaluators regarding predicted healing looking at OCT and OMAG scans (Kappa 0.003). There was moderate agreement between evaluators predicting healing from photos (Kappa 0.047). Conclusions This preliminary data demonstrates that quantitative OCT/OMAG data shows promise in predicting which patients undergo surgical therapy. Variation of healing estimates from provider image assessment support the best use of this tool as a quantitative measure. Larger studies are needed to explore these findings and the role of this technology. Applicability of Research to Practice OCT/OMAG is a quantitative tool that shows promise in predicting which patients undergo surgical therapy.