• Keng Siang Lee, Amber Young, Hayley King, JenkinsA Toby AATADepartment of Chemistry, University of Bath, BA2 7AY, United Kingdom., and Anna Davies.
• Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, United Kingdom.
• Burns. 2022 Feb 1; 48 (1): 1121-12.

IntroductionSystematic reviews (SR) of high-quality randomised controlled trials can identify effective treatments for burn wound infections (BWIs). Clinical heterogeneity in outcome definitions can prevent valid evidence synthesis, which may limit the reliability of the findings of SRs affected by this heterogeneity. This SR aimed to investigate whether there is variation BWI definitions across studies in SRs of burn care interventions and its impact on identification of effective treatments for patients with burn injuries.MethodsA systematic search of five databases was conducted. Included SRs were: in English, published from January 2010 to October 2018, assessed intervention effects for patients with a burn injury, and reported data about BWI.ResultsTwenty-nine SRs, which included 248 studies reporting BWI outcomes, were included in our final dataset. Three SRs used a definition of BWI to select studies for inclusion. Fourteen reported BWI definitions from included studies in the review results. There was heterogeneity of BWI definition in their included studies; across 29 SRs, 32 different BWI indicators were used, with the median across SRs ranging from 1 to 7 (range 1-14). Fourteen SRs accounted for BWI definition heterogeneity in their conclusions, indicating that the issue impacted whether a conclusion could be drawn, and limited the validity of the SR findings.ConclusionsThere is variation in BWI definition across SRs and within the studies included in SRs of interventions assessing BWI outcomes. This heterogeneity has prevented conclusions about intervention effects being drawn, and only half of the SR authors have accounted for it in their findings. Reviews that have collated this data without reference to the heterogeneity should be viewed with caution, since it may limit the validity of evidence for the identification of effective treatments for BWI. The use of a newly developed core indicator set to support consistent reporting of indicators and standardisation of BWI outcome reporting will enable effective evidence synthesis.Copyright © 2021 Elsevier Ltd and ISBI. All rights reserved.

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