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The current standard for assessment of burn severity and subsequent wound healing is through clinical examination, which is highly subjective. Accurate early assessment of burn severity is critical for dictating the course of wound management. Complicating matters is the fact that burn wounds are often large and can have multiple regions that vary in severity. In order to manage the treatment more effectively, a tool that can provide spatially resolved information related to mapping burn severity could aid clinicians when making decisions. Several new technologies focus on burn care in an attempt to help clinicians objectively determine burn severity. By quantifying perfusion, laser speckle imaging (LSI) has had success in categorizing burn wound severity at earlier time points than clinical assessment alone. Additionally, spatial frequency domain imaging (SFDI) is a new technique that can quantify the tissue structural damage associated with burns to achieve earlier categorization of burn severity. Here we compared the performance of a commercial LSI device (PeriCam PSI, Perimed Inc.), a SFDI device (Reflect RSTM, Modulated Imaging Inc.) and conventional clinical assessment in a controlled (porcine) model of graded burn wound severity over the course of 28 days. Specifically we focused on the ability of each system to predict the spatial heterogeneity of the healed wound at 28 days, based on the images at an early time point. Spatial heterogeneity was defined by clinical assessment of distinct regions of healing on day 28. Across six pigs, 96 burn wounds (3 cm diameter) were created. Clinical assessment at day 28 indicated that 39 had appeared to heal in a heterogeneous manner. Clinical observation at day 1 found 35 / 39 (90%) to be spatially heterogeneous in terms of burn severity. The LSI system was able to detect spatial heterogeneity of burn severity in 14 / 39 (36%) cases on day 1 and 23 / 39 cases (59%) on day 7. By contrast the SFDI system was able to detect spatial heterogeneity of burn severity in 39 / 39 (100%) cases on day 1. Here we have demonstrated that for the purposes of predicting heterogeneity in wound healing, SFDI generated scattering properties were a significantly more effective tool than perfusion images measured using LSI. This indicates that SFDI may be better suited to help clinicians categorize different burns earlier, ultimately informing treatment strategy to improve patient outcomes.
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