Difference between revisions of "Perrins"
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| − | '''<span style="font-family: | + | <span style="font-size:x-large;">'''<span style="font-family: " times="" new="" roman",="" serif;"="">Hyperbaric oxygen improved the percentage of take in split-thickness skin grafts after thermal burns</span>'''</span> |
<span style="border-color: windowtext; border-style: solid; border-width: 1.5pt; display: block; padding: 1pt 4pt;"><span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Clinical Bottom Line:</span>''' <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1. The percentage of graft take was significantly higher when treatment included hyperbaric oxygenation. 2. Total or near total take was achieved in 64% of hyperbaric treated grafts.</span></span></span> | <span style="border-color: windowtext; border-style: solid; border-width: 1.5pt; display: block; padding: 1pt 4pt;"><span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Clinical Bottom Line:</span>''' <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1. The percentage of graft take was significantly higher when treatment included hyperbaric oxygenation. 2. Total or near total take was achieved in 64% of hyperbaric treated grafts.</span></span></span> | ||
| − | + | '''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Appraised by:</span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Mike Bennett, Prince of Wales Hospital, Dept. of Diving and Hyperbaric Medicine Sydney; Wednesday, December 02, 19</span> | |
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| − | <span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> | + | '''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Clinical Scenario: </span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">A patient with full-thickness burns to a limb and requiring skin grafts</span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">.</span>''' |
| − | + | <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">T'''hree-part Question: '''In patients with full-thickness thermal burns requiring skin grafts, does the application of hyperbaric oxygen compared to normal post-graft care, result in any increased graft survival?</span> | |
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| − | + | '''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Search Terms:</span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> hyperbaric oxygenation, burn/thermal, skin graft.</span> | |
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| − | <span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> | + | '''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The Study: </span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Single-blinded randomized controlled trial with intention-to-treat.</span> <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Patients with burns presenting for split thickness skin grafting.</span> |
| − | + | <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">'''Control group''' (N = 24; 24 analysed): Split-thickness skin grafting to the burn area, suitable and closed dressings of paraffin gauze, cotton wool and bandages. No sham treatment.</span> | |
| − | + | ||
| + | <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">'''Experimental group '''(N = 24; 24 analysed): As above plus oxygen at 2ATA for 2 hours that evening and twice daily for three days.</span> | ||
| + | |||
| + | '''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The Evidence:</span>''' | ||
{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
|- | |- | ||
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Outcome</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Time to Outcome</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Control</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBO</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Relative risk reduction</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Absolute risk reduction</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">NNT</span></span>'''</span> |
|- | |- | ||
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">>95% graft take</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3 days</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.167</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.63</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">277%</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.46</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2</span></span></span> |
|- | |- | ||
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">95% CI</span></span>'''</span> |
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | ||
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| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | ||
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">100% to 131%</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.22 to 0.71</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1 to 5</span></span></span> |
|- | |- | ||
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">>60% graft take</span></span>'''</span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3 days</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.625</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1.0</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">60%</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.38</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3</span></span></span> |
|- | |- | ||
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">95% CI</span></span>'''</span> |
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | ||
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| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | ||
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">29% to 91%</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.18 to 0.57</span></span></span> |
| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2 to 6</span></span></span> |
|} | |} | ||
| − | <br/> | + | <br/> |
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| + | <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">'''Comments:'''</span> <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1. Only the operator was blind to treatment allocation.</span> <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">2. Randomization process not defined.</span> <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">3. Now over thirty years since trial and current success rate of grafts may be important in interpretation.</span> <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">4. No indication of the distribution of confounders given.</span> | ||
| + | |||
| + | '''Expiry date''': '''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">July 2023</span>''' | ||
| − | + | '''<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">References:</span>''' | |
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<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1. Perrins DJD. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet 1967; 7495:868-871.</span> | <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1. Perrins DJD. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet 1967; 7495:868-871.</span> | ||
Revision as of 02:00, 22 July 2019
Hyperbaric oxygen improved the percentage of take in split-thickness skin grafts after thermal burns
Clinical Bottom Line: 1. The percentage of graft take was significantly higher when treatment included hyperbaric oxygenation. 2. Total or near total take was achieved in 64% of hyperbaric treated grafts.
Appraised by:Mike Bennett, Prince of Wales Hospital, Dept. of Diving and Hyperbaric Medicine Sydney; Wednesday, December 02, 19
Clinical Scenario: A patient with full-thickness burns to a limb and requiring skin grafts.
Three-part Question: In patients with full-thickness thermal burns requiring skin grafts, does the application of hyperbaric oxygen compared to normal post-graft care, result in any increased graft survival?
Search Terms: hyperbaric oxygenation, burn/thermal, skin graft.
The Study: Single-blinded randomized controlled trial with intention-to-treat. Patients with burns presenting for split thickness skin grafting.
Control group (N = 24; 24 analysed): Split-thickness skin grafting to the burn area, suitable and closed dressings of paraffin gauze, cotton wool and bandages. No sham treatment.
Experimental group (N = 24; 24 analysed): As above plus oxygen at 2ATA for 2 hours that evening and twice daily for three days.
The Evidence:
|
Outcome |
Time to Outcome |
Control |
HBO |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
>95% graft take |
3 days |
0.167 |
0.63 |
277% |
0.46 |
2 |
|
95% CI |
100% to 131% |
0.22 to 0.71 |
1 to 5 | |||
|
>60% graft take |
3 days |
0.625 |
1.0 |
60% |
0.38 |
3 |
|
95% CI |
29% to 91% |
0.18 to 0.57 |
2 to 6 |
Comments: 1. Only the operator was blind to treatment allocation. 2. Randomization process not defined. 3. Now over thirty years since trial and current success rate of grafts may be important in interpretation. 4. No indication of the distribution of confounders given.
Expiry date: July 2023
References:
1. Perrins DJD. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet 1967; 7495:868-871.
