Difference between revisions of "Brannen"

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'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">The addition of hyperbaric oxygenation therapy to thermal burns patients did not result in improved outcome.</span>'''
 
  
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<span style="border: 1.5pt solid windowtext; display: block; padding: 1pt 4pt;"><span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Clinical Bottom Line:</span>'''
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"="">The addition of hyperbaric oxygenation therapy to thermal burns patients did not result in improved outcome.</span></span>'''</span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">1. The addition of hyperbaric oxygen did not affect mortality, length of stay or number of surgical procedures required. (LOS and mortality analysed by logistic regression)
 
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2. No important benefit of HBO in thermal burns was identified. </span></span>
 
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</span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Appraised by:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Sydney; Friday, 04 December, 1998</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Clinical Scenario:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> A patient with thermal burns presenting for early treatment in a specialist burns centre.</span>
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<span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical Bottom Line:</span></span>'''</span>
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Three-part Question:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> In patients with thermal burns, does the addition of hyperbaric oxygen therapy to a standard care protocol result in any improvement in the time taken to heal, or quality of scarring?</span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Search Terms:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> Hyperbaric oxygenation, burns/thermal.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">The Study:</span>'''
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. The addition of hyperbaric oxygen did not affect mortality, length of stay or number of surgical procedures</span></span></span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Non-blinded randomised controlled trial with intention-to-treat.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Adult patients with skin burns, with or without airway /inhalation injury, referred to a tertiary care burns centre in the first 24 hours.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">'''Control group''' (N = 62; 62 analysed): Usual burn care.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">'''Experimental group''' (N = 63; 63 analysed): Usual burn care plus oxygen at 2ATA for 90 minutes twice daily for a minimum of 5 days and a maximum number of treatments equal to % burn area.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">The Evidence:</span>'''
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">2. No important benefit of hyperbaric oxygen identified</span></span></span>
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{|
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Time to Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Normal care rate</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Hyperbaric care rate</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Relative risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Absolute risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">NNT</span>'''</span></span>  
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----
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Citation(s):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E, Thompson W. A randomized prospective trial of hyperbaric oxygen in a referral burn centre population. The American Surgeon 1997; 63:205-208.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical Scenario:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">A patient with thermal burns presenting for early treatment in a specialist burns centre.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Three-part Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">In patients with thermal burns, does the addition of hyperbaric oxygen therapy to a standard care protocol result in any improvement in the time taken to heal, or quality of scarring?</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Hyperbaric oxygenation, burns/thermal.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Non-blinded randomised controlled trial with intention-to-treat. Adult patients with skin burns, with or without airway /inhalation injury, referred to a tertiary care burns centre in the first 24 hours.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">(N = 62; 62 analysed): Usual burn care.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Experimental group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">(N = 63; 63 analysed): Usual burn care plus oxygen at 2ATA for 90 minutes twice daily for a minimum of 5 days and a maximum number of treatments equal to % burn area.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Evidence:</span></span>'''</span>
 +
 
 +
{| class="Table" style="border: 1pt solid windowtext; width: 714px;"
 
|-
 
|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Death</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">As required</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.113</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.111</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">2%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.002</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">500</span></span>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to Outcome</span></span>'''</span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control rate</span></span>'''</span></p>
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| style="width:51.1pt; border:solid windowtext 1.0pt" width="68" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBO rate</span></span>'''</span></p>
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| style="width:83.55pt; border:solid windowtext 1.0pt" width="111" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Relative risk reduction</span></span>'''</span></p>
 +
| style="width:77.05pt; border:solid windowtext 1.0pt" width="103" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Absolute risk reduction</span></span>'''</span></p>
 +
| style="width: 107px; border: 1pt solid windowtext;" width="87" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT</span></span>'''</span></p>  
 
|-
 
|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">95% CI</span>'''</span></span> ||  ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-96% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-0.12 to 0.11</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">NNT'''9 to INF NNH=9 to INF</span></span>  
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| rowspan="2" style="border:solid windowtext 1.0pt" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Death</span></span>'''</span>
 +
 
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">As required</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.11</span></span></span></p>
 +
| style="width:51.1pt; border:solid windowtext 1.0pt" width="68" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.11</span></span></span></p>
 +
| style="width:83.55pt; border:solid windowtext 1.0pt" width="111" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">2%</span></span></span></p>
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| style="width:77.05pt; border:solid windowtext 1.0pt" width="103" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.002</span></span></span></p>
 +
| style="width: 107px; border: 1pt solid windowtext;" width="87" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">500</span></span></span></p>  
 
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|-
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| colspan="3" style="width:166.55pt; border:solid windowtext 1.0pt" width="222" | <p align="right" style="margin-bottom:0cm; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI</span></span></span></p>
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| style="width:83.55pt; border:solid windowtext 1.0pt" width="111" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-96% to 100%</span></span></span></p>
 +
| style="width:77.05pt; border:solid windowtext 1.0pt" width="103" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.12 to 0.11</span></span></span></p>
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| style="width: 107px; border: 1pt solid windowtext;" width="87" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT=9 to INF NNH=9 to INF</span></span></span></p>
 
|}
 
|}
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Comments:</span>'''
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Comments:</span></span>'''</span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">1. Potential for selection bias as randomization depended on availability of HBO facility.</span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">2. No attempt to blind patients or staff.</span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Potential for selection bias as randomization depended on availability of HBO facility.</span></span></span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">3. No analysis of graft survival or long-term outcome.</span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">4. No analysis of the modification of acute care that may have accompanied HBO treatment.</span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">2. No attempt to blind patients or staff.</span></span></span>
−
<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">5. Most were quite small burn areas and these results may not apply to larger burns.</span>
+
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3. No analysis of graft survival or long-term outcome.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">4. No analysis of the modification of acute care that may have accompanied HBO treatment.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">5. Most were quite small burn areas and these results may not apply to larger burns.</span></span></span>
 +
 
 +
&nbsp;
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Friday, 04 December, 1998</span></span></span>
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Expiry date:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> December 2024</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Expiry date:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">December 2024</span></span></span>
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">References: </span>'''
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">1. Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E, Thompson W. A randomized prospective trial of hyperbaric oxygen in a referral burn centre population. The American Surgeon 1997; 63:205-208.</span>
 
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<span style="display: block; text-align: center;">
 
  
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</span>
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
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[[File:sumhorsa.gif|center]]
 
  
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Burns | BACK]]'''</span>
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Burns|BACK]]'''</span>

Latest revision as of 21:29, 9 October 2021

The addition of hyperbaric oxygenation therapy to thermal burns patients did not result in improved outcome.

Clinical Bottom Line:

1. The addition of hyperbaric oxygen did not affect mortality, length of stay or number of surgical procedures

2. No important benefit of hyperbaric oxygen identified

Citation(s):1. Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E, Thompson W. A randomized prospective trial of hyperbaric oxygen in a referral burn centre population. The American Surgeon 1997; 63:205-208.

Clinical Scenario:A patient with thermal burns presenting for early treatment in a specialist burns centre.

Three-part Question:In patients with thermal burns, does the addition of hyperbaric oxygen therapy to a standard care protocol result in any improvement in the time taken to heal, or quality of scarring?

Search Terms:Hyperbaric oxygenation, burns/thermal.

The Study:Non-blinded randomised controlled trial with intention-to-treat. Adult patients with skin burns, with or without airway /inhalation injury, referred to a tertiary care burns centre in the first 24 hours.

Control group(N = 62; 62 analysed): Usual burn care.

Experimental group(N = 63; 63 analysed): Usual burn care plus oxygen at 2ATA for 90 minutes twice daily for a minimum of 5 days and a maximum number of treatments equal to % burn area.

The Evidence:

Outcome

Time to Outcome

Control rate

HBO rate

Relative risk reduction

Absolute risk reduction

NNT

Death

As required

0.11

0.11

2%

0.002

500

95% CI

-96% to 100%

-0.12 to 0.11

NNT=9 to INF NNH=9 to INF

Comments:

1. Potential for selection bias as randomization depended on availability of HBO facility.

2. No attempt to blind patients or staff.

3. No analysis of graft survival or long-term outcome.

4. No analysis of the modification of acute care that may have accompanied HBO treatment.

5. Most were quite small burn areas and these results may not apply to larger burns.

 

Appraised by:Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Friday, 04 December, 1998

Expiry date:December 2024

Sumhorsa.gif

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