RESUMO
The clinical effectiveness and scar quality of the randomized controlled trial comparing enzyme alginogel with silver sulfadiazine (SSD) for treatment of partial thickness burns were previously reported. Enzyme alginogel did not lead to faster wound healing (primary outcome) or less scar formation. In the current study, the health-related quality of life (HRQoL), costs, and cost-effectiveness of enzyme alginogel compared with SSD in the treatment of partial thickness burns were studied. HRQoL was evaluated using the Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L questionnaire 1 week before discharge and at 3, 6, and 12 months postburn. Costs were studied from a societal perspective (health care and nonhealth-care costs) for a follow-up period of 1 year. A cost-effectiveness analysis was performed using cost-effectiveness acceptability curves and comparing differences in societal costs and Quality Adjusted Life Years (QALYs) at 1 year postburn. Forty-one patients were analyzed in the enzyme alginogel group and 48 patients in the SSD group. None of the domains of BSHS-B showed a statistically significant difference between the treatment groups. Also, no statistically significant difference in QALYs was found between enzyme alginogel and SSD (difference -0.03; 95% confidence interval [CI], -0.09 to 0.03; P = .30). From both the health care and the societal perspective, the difference in costs between enzyme alginogel and SSD was not statistically significant: the difference in health-care costs was 3210 (95% CI, -1247 to 7667; P = .47) and in societal costs was 3377 (95% CI -6229 to 12 982; P = .49). The nonsignificant differences in costs and quality-adjusted life-years in favor of SSD resulted in a low probability (<25%) that enzyme alginogel is cost-effective compared to SSD. In conclusion, there were no significant differences in quality of life between both treatment groups. Enzyme alginogel is unlikely to be cost-effective compared with SSD in the treatment of partial thickness burns.
Assuntos
Alginatos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Queimaduras/economia , Queimaduras/terapia , Glucose Oxidase/uso terapêutico , Lactoperoxidase/uso terapêutico , Polietilenoglicóis/uso terapêutico , Qualidade de Vida , Sulfadiazina de Prata/uso terapêutico , Adulto , Idoso , Alginatos/economia , Anti-Infecciosos Locais/economia , Queimaduras/patologia , Análise Custo-Benefício , Combinação de Medicamentos , Feminino , Glucose Oxidase/economia , Humanos , Lactoperoxidase/economia , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/economia , Sulfadiazina de Prata/economia , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two-arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty-one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8-49 days) versus 16 days with Flamazine® (range 7-48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain-related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.
Assuntos
Alginatos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Queimaduras/tratamento farmacológico , Cicatriz/patologia , Glucose Oxidase/uso terapêutico , Lactoperoxidase/uso terapêutico , Polietilenoglicóis/uso terapêutico , Sulfadiazina de Prata/uso terapêutico , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos/patologia , Adulto , Idoso , Alginatos/farmacologia , Anti-Infecciosos Locais/farmacologia , Queimaduras/patologia , Cicatriz/prevenção & controle , Combinação de Medicamentos , Feminino , Glucose Oxidase/farmacologia , Humanos , Lactoperoxidase/farmacologia , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/farmacologia , Reepitelização/efeitos dos fármacos , Sulfadiazina de Prata/farmacologia , Resultado do Tratamento , Cicatrização/fisiologia , Infecção dos Ferimentos/tratamento farmacológicoRESUMO
Itch is a common problem after burns. Although the topic receives increasing attention, the number of prospective studies is limited. The aim of this study was to assess the influence of acute traumatic stress symptoms, controlled for injury characteristics, age and sex, on itch over a period of 18 months using multilevel analysis. A total of 226 respondents provided itch scores. Participants completed the Burn Itch Questionnaire during admission (n = 208) and at 3 (n =179), 12 (n =143) and 18 (n =99) months post-burn. They completed the Impact of Event Scale to assess acute traumatic stress symptoms during admission. Skin graft requirement, a higher level of acute traumatic stress symptoms and younger age were statistically significant predictors of a higher itch score. Younger age was particularly associated with higher itch scores during admission, whereas the effect of skin grafting was particularly observed at 3 months post-burn. This study replicates the predictive role of traumatic stress symptoms, which warrants further research.
Assuntos
Queimaduras/complicações , Prurido/etiologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Idoso , Bélgica , Queimaduras/diagnóstico , Queimaduras/psicologia , Queimaduras/cirurgia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Prurido/diagnóstico , Prurido/psicologia , Fatores de Risco , Índice de Gravidade de Doença , Transplante de Pele , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Partial thickness burns are painful, difficult to manage and can have a negative effect on quality of life through scarring, permanent disfigurement and loss of function. The aim of burn treatment in partial thickness burns is to save lives, stimulate wound healing by creating an optimumly moist wound environment, to have debriding and analgesic effects, protect the wound from infection and be convenient for the patient and caregivers. However, there is no consensus on the optimal treatment of partial thickness wounds. Flaminal® and Flamazine® are two standard treatment options that provide the above mentioned properties in burn treatment. Nevertheless, no randomized controlled study has yet compared these two common treatment modalities in partial thickness burns. Thus, the aim of this study is to evaluate the clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns. METHODS/DESIGN: In this two-arm open multi-center randomized controlled trial, 90 patients will be randomized between Flaminal® and Flamazine® and followed for 12 months. The study population will consist of competent or temporarily non-competent (because of sedation and/or intubation) patients, 18 years of age or older, with acute partial thickness burns and a total body surface area (TBSA) of less than 30 %. The main study outcome is time to complete re-epithelialization (greater than 95 %). Secondary outcome measures include need for grafting, wound colonization/infection, number of dressing changes, pain and anxiety, scar formation, health-related quality of life (HRQoL), and costs. DISCUSSION: This study will contribute to the optimal treatment of patients with partial thickness burn wounds and will provide evidence on the (cost-)effectiveness and quality of life of Flaminal® versus Flamazine® in the treatment of partial thickness burns. TRIAL REGISTRATION: Netherlands Trial Register NTR4486 , registered on 2 April 2014.
Assuntos
Alginatos/economia , Alginatos/uso terapêutico , Anti-Infecciosos Locais/economia , Anti-Infecciosos Locais/uso terapêutico , Queimaduras/tratamento farmacológico , Queimaduras/economia , Custos de Medicamentos , Glucose Oxidase/economia , Glucose Oxidase/uso terapêutico , Lactoperoxidase/economia , Lactoperoxidase/uso terapêutico , Polietilenoglicóis/economia , Polietilenoglicóis/uso terapêutico , Qualidade de Vida , Sulfadiazina de Prata/economia , Sulfadiazina de Prata/uso terapêutico , Pele/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Alginatos/efeitos adversos , Anti-Infecciosos Locais/efeitos adversos , Queimaduras/complicações , Queimaduras/psicologia , Cicatriz/etiologia , Cicatriz/terapia , Protocolos Clínicos , Análise Custo-Benefício , Combinação de Medicamentos , Glucose Oxidase/efeitos adversos , Humanos , Lactoperoxidase/efeitos adversos , Países Baixos , Dor/etiologia , Polietilenoglicóis/efeitos adversos , Reepitelização/efeitos dos fármacos , Projetos de Pesquisa , Sulfadiazina de Prata/efeitos adversos , Pele/patologia , Transplante de Pele , Fatores de Tempo , Resultado do Tratamento , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/terapiaRESUMO
The evidence for application of silver-containing dressings and topicals in the treatment of partial-thickness burns in pediatric patients is largely based on clinical trials involving adult patients despite the important differences between the skin of children and adults. A systematic review and meta-analysis was performed of all randomized controlled trials comparing nonsilver treatment with silver-containing dressings and silver topical agents in children with partial-thickness burns in the acute stage. Endpoints were wound healing, grafting, infection, pain, number of dressing changes, length of hospital stay, and scarring. Seven randomized controlled trials were included involving 473 participants. All trials used silver sulfadiazine as control in comparison with five different nonsilver treatments. Most trials were of moderate quality with high risk of bias. Use of nonsilver treatment led to shorter wound healing time (weighted mean difference: -3.43 days, 95% confidence interval: -4.78, -2.07), less dressing changes (weighted mean difference: -19.89 dressing changes, 95% confidence interval: -38.12, -1.66), and shorter length of hospital stay (weighted mean difference: -2.07 days, 95% confidence interval: -2.63, -1.50) compared with silver sulfadiazine treatment, but no difference in the incidence of wound infection or grafting was found. In conclusion, nonsilver treatment may be preferred over silver sulfadiazine, but high-quality randomized controlled trials are needed to validly confirm the effectiveness of silver containing preparations, in particular silver-containing dressings, above nonsilver treatments.