• Apinut Wongkietkachorn, Palakorn Surakunprapha, Kengkart Winaikosol, Sakda Waraasawapati, Surachat Chaiwiriyakul, Kant Eua-Angkanakul, Nuttapone Wongkietkachorn, Pattama Punyavong, Kamonwan Jenwitheesuk, and Bowornsilp Chowchuen.
• From the Division of Plastic and Reconstructive Surgery, Department of Surgery (A.W.), Faculty of Medicine, Mae Fah Luang University, Chiang Rai; Division of Plastic and Reconstructive Surgery, Department of Surgery (P.S., K.W., P.P., K.J., B.C.), Department of Pathology, Faculty of Medicine (S.W., S.C.), Khon Kaen University; Division of Plastic and Reconstructive Surgery, Department of Surgery (K.E.), Khon Kaen Hospital, Khon Kaen; and Division of Plastic and Reconstructive Surgery, Department of Surgery (N.W.), Q Clinic, Bangkok, Thailand.
• J Trauma Acute Care Surg. 2019 May 1; 86 (5): 823-828.

BackgroundClinical assessment of indeterminate burn wounds has been reported to yield poor accuracy, even when performed by burn experts. Indocyanine green (ICG) dye angiography has been found to be highly accurate in assessing burn depth, but there is still limited evidence of its use in indeterminate burn wounds. This study aims to compare the accuracy of ICG angiography to that of clinical assessment in assessing indeterminate burn wounds.MethodsThis is a prospective, multicentered, triple-blinded, experimental study. Participants were stable patients, admitted to the hospital with burn wounds of indeterminate depth. The burn wounds were clinically assessed by an attending plastic surgeon. ICG angiography was performed and evaluated by another surgeon. Tissue biopsies were obtained and sent for histological study to be assessed as the gold standard.ResultsIn the 30 burn sites that were assessed, the accuracy of ICG angiography was 100.0%, compared with 50.0% for clinical assessment (p < 0.001). Clinical assessment yielded a sensitivity of 33.3% and specificity of 66.7%, while ICG angiography yielded both a sensitivity and specificity of 100.0%. Therefore, the number needed to treat for using ICG angiography in indeterminate burn wounds was two.ConclusionIndocyanine green angiography yields a significantly higher accuracy than clinical assessment in indeterminate burn wounds. This intervention can, thus, be a useful tool to aid clinical judgment.Trial RegistrationThai Clinical Trials Registry, number TCTR20170821001.Level Of EvidenceDiagnostic test, level I.

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