No Clear Winner Among Dressings for Partial-Thickness Burns

Article Outline

• Methods
• Commentary
• Results
  • Systematic Review Author Contact
• References
• Copyright

Methods 

Data Sources

The authors searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Wounds Group Specialized Register (May 29, 2008), MEDLINE (1950 to May 2008), EMBASE (1980 to May 2008), and CINAHL (1982 to May 2008).

Study Selection

The review included randomized controlled trials examining various burn dressings, frequently using silver sulfadiazine as a control. Dressing types included the following:

Studies addressing topical skin agents, full-thickness burns, hand burns, and biological skin replacements were excluded.

The primary outcomes included time to complete wound healing and change in wound surface area over time. Secondary outcomes included number of dressing changes, pain, patient satisfaction, infection rate, need for surgery, cost, and hospital length of stay.

Data Extraction and Synthesis

Studies were reviewed by 2 authors independently and data were abstracted using standardized forms. The authors abstracted and pooled data from eligible studies by using appropriate analytical methods according to the Cochrane Handbook, version 5.0.0.

Studies were assessed for the adequacy of randomization and allocation concealment, blinding of providers and participants, potential selection bias after allocation, and completeness of follow-up.

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Commentary 

Approximately 500,000 patients present to US emergency departments (EDs) for burns each year, but fewer than 10% (40,000) are admitted to hospitals.¹ It is therefore the responsibility of emergency physicians to initiate appropriate wound dressings for the majority of burn victims.

In treating partial-thickness burns, dressing strategies are divided into 2 general categories: (1) open methods, consisting of topical antimicrobials; and (2) closed methods, which use various occlusive dressings.¹

This Cochrane Review summarizes the literature addressing closed methods of treating partial-thickness burns. The Cochrane authors found the literature for each dressing type to be limited both in quantity and in methodological quality. Thus, there are insufficient data to recommend a specific dressing in the management of partial-thickness burns.

Although this review did not specifically address the efficacy of silver sulfadiazine, 6 of the 7 closed dressings examined were superior to silver sulfadiazine dressings with respect to time to complete healing, which is consistent with other reports in the literature suggesting quicker healing with interventions ranging from collagenase ointment with bacitracin² to honey.³ The practice of routinely treating partial-thickness burns with silver sulfadiazine should be reexamined.

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Results 

Twenty-six studies met the inclusion criteria and generally enrolled similar patient populations. Patients were recruited from the ED, outpatient settings, and tertiary burn centers. They were organized according to study intervention.

Overall study quality was rated poor to very poor. Fewer than 50 patients were enrolled in half of the included studies, and only one study enrolled more than 100 patients. Six of 26 studies used an adequate randomization strategy and 5 documented allocation concealment. Only 3 trials used blinded assessment of wound healing. Baseline clinical characteristics were comparable.

The results of included studies were largely reported separately for each type of intervention because of wide variation in study design, comparators, and outcomes measured.

Burns treated with hydrocolloid, polyurethane film, hydrogel, biosynthetic, and silver-impregnated dressings appear to heal more rapidly than those treated with silver sulfadiazine dressings. There was no difference in healing times between biosynthetic dressings and hydrocolloids or between fiber dressings and silver sulfadiazine.

All intervention dressings except silver-impregnated dressings appear to reduce patient discomfort compared with silver sulfadiazine or chlorhexidine dressings. Hydrocolloid, silicon-coated, and silver-impregnated dressings reduce the number of required dressing changes.

Incidence of infection was difficult to estimate because of inconsistent reporting and vague definitions of this outcome. No studies demonstrated a statistically significant difference between any of the modalities investigated, although there was a trend toward lower infection rates in 2 trials for burns treated with silver sulfadiazine.

Systematic Review Author Contact 

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References 

1. Singer AJ, Tiara BR, Lee CC. Thermal burns. In:  Marx JA,  Hockberger RS,  Walls RM editor. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed.. Philadelphia, PA: Mosby/Elsevier; 2010;p. 764–765
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2. Soroff H, Sasvary D. Collagenase ointment and polymyxin B sulfate/bacitracin spray versus silver sulfadiazine cream in partial-thickness burns: a pilot study. J Burn Care Rehabil. 1994;15:13–17
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3. Subrahmanyam M. A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns. 1998;24:157–161
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