Dressing and topical agents for burns (Protocol)

Campbell F, Seers K

This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane
Library 2007, Issue 2

http://www.thecochranelibrary.com

Dressing and topical agents for burns (Protocol) 1

Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
 TABLE OF CONTENTS
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW . . . . . . . . . . . . . . . . . . 2
SEARCH METHODS FOR IDENTIFICATION OF STUDIES . . . . . . . . . . . . . . . . . . . 2
METHODS OF THE REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
POTENTIAL CONFLICT OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
COVER SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Dressing and topical agents for burns (Protocol) i

Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Dressing and topical agents for burns (Protocol)

Campbell F, Seers K

This record should be cited as:

Campbell F, Seers K. Dressing and topical agents for burns. (Protocol) Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.:
CD002106. DOI: 10.1002/14651858.CD002106.

This version first published online: 24 April 2000 in Issue 2, 2000.

Date of most recent substantive amendment: 17 February 2000

ABSTRACT
This is the protocol for a review and there is no abstract. The objectives are as follows:
To undertake a systematic review of reliable evidence concerning dressings and topical agents applied to burn wounds. Specific questions
to be answered are:
1) Is there any difference in the effectiveness and side effects of different dressings?
2) Is there any difference in the effectiveness and side effects of dressings and topical agents?
3) Is there any difference in the effectiveness and side effects of different topical agents

BACKGROUND in a number of different ways including the Lund and Browder

chart or a patient’s hand size, which is approximately 1% TBSA .

There is insufficient data to estimate precisely the numbers of burn
injuries suffered each year in different countries. Annual estimates
for the numbers of people seeking medical attention for burn
injuries is 1.25 million in the U.S. (Brigham) and 120,000 in the
UK (Home Office). Surveys reveal that children are particularly
vulnerable to this type of injury. Data from Switzerland showed the
incidence of burns amongst children to be as high as 224 per 1000
children (Addor). In contrast the annual incidence of burns for
the whole population is 4.7 per 1000 people (Arturson). Statistics
show that the number of productive years lost from burns is greater
than that from cancer or heart disease because of the early age at
which burn victims are involved (Arturson).
Patients suffering a burn can present with a wide spectrum of injury
severity depending on the depth of the wound and the proportion
of the body which is affected. A burn may be superficial, involving
just the epidermal layer of the skin. Partial thickness burns will
involve damage to more structures within the skin such as blood
vessels, nerves and hair follicles whilst full thickness burns will
involve all layers of the skin and may involve the structures beneath
such as muscle and bone.
The extent of the injury is usually expressed in percent of total
body surface area (TBSA) which is burnt. This can be calculated
Dressing and topical agents for burns (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Burn wounds are most commonly dressed using a combination
of paraffin-impregnated gauze (designed to prevent adherence of
the dressing to the wound) and an absorbant cotton wool layer
(Lawrence). Silver sulphadiazine (SSD) has also been commonly
used in burn wound management since 1968 to try and overcome
the problem of wound infection.
A number of dressings and topical agents have evolved for use
on burn wounds as a consequence of improved understanding of
wound healing. Dressings and topical agents have been classified
in various ways, e.g. according to whether they are presented as
a film, or a foam; whether they are made from traditional (e.g.
gauze), modern (e.g. foams) or biological materials (e.g. animal
skin (xenograft) or human donor skin (allograft))(Queen). The
range of dressings includes:
i) film dressings
ii) hydrocolloids
iii) hydropolymer dressings.
iv) foam dressings
v) alginates
vi) gauze / gauze type dressings
vii) hydrogels
viii) topical antimicrobials
ix) biological dressings
1
OBJECTIVES
To undertake a systematic review of reliable evidence concern-
ing dressings and topical agents applied to burn wounds. Specific
questions to be answered are:
1) Is there any difference in the effectiveness and side effects of
different dressings?
2) Is there any difference in the effectiveness and side effects of
dressings and topical agents?
3) Is there any difference in the effectiveness and side effects of
different topical agents
CRITERIA FOR CONSIDERING
STUDIES FOR THIS REVIEW
Types of studies
Randomised controlled trials evaluating dressings or topical agents
in the treatment of burns. Trials which have no objective measure
of any of the outcomes identified will be excluded.
Types of participants
People of any age with a burn wound which required treatment in
any care setting. This will include all types of burns and burns of
all thicknesses. It will not however be including studies concerned
with the treatment of the skin graft donor site.
Types of intervention
A wound dressing or topical agent applied to a burn wound.
The specific comparisons to be made are:
• no dressing (air exposure) versus a dressing
• no dressing (air exposure) versus a topical agent
• dressings versus dressings
• dressings versus topical agents
• topical agents versus topical agents
Types of outcome measures
1) Healing rates
There is no consensus as to the most valid and reliable means
of measuring healing rates of wounds. Trials will be included if
they measure healing by some objective method such as time to
complete healing, or rate of change in the area/volume of the
wound.
2) Infection rates
3) Pain
4) Costs of the dressings and topical agents
5) Appearance of the scar
6) Graft take (proportion of ulcer area covered in viable graft
at follow-up) applicable to studies which use biological dressings
prior to the application of a skin graft (autograft or allograft)
Dressing and topical agents for burns (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
7) Time taken for ulcer bed to be considered ready for grafting
8) Number of dressing changes.
SEARCH METHODS FOR
IDENTIFICATION OF STUDIES
See: methods used in reviews.
References to trials will be sought from the Cochrane Wounds
Group Register of Trials (see Wounds Group Search Strategy).
We will also contact manufacturers and distributors of dressings
and topical agents for details of unpublished or ongoing studies.
There will be no restriction on the inclusion of reports based on
language of publication, or publication status.
METHODS OF THE REVIEW
References identified from searches will be reviewed by two
reviewers who will jointly decide wether to include or exclude a
study. Data extraction will be undertaken by two reviewers and
summarised using a data extraction sheet. Any discrepancy will be
resolved by discussion.
The following data will be extracted from each report:
-care setting
-key baseline variables of each group eg. depth of burn wound,
size of burn wound, burn type, age, sex , any concurrent disease
-exclusion/inclusion criteria
-numbers in each group
-description of the intervention and the control or co-intervention
including: secondary dressings used, frequency of dressings
changes, length of treatment
-outcomes
Authors will be contacted where further data, or clarification, is
needed.
The methodological quality of each trial will also be assessed:
1) Method of randomisation and allocation concealment
2) Blinding of patients, clinicians and outcome assessors
3) The reporting of withdrawals from studies and intention to
treat analysis.
4) Evidence of an a priori sample size calculation.
Data will be entered onto the Cochrane RevMan software and
analysed using Cochrane Metaview. Results will be presented with
95% confidence intervals. Summary estimates for dichotomous
outcomes will be reported as odds ratios or relative risk. If the
event rates are greater than 30% then relative risk will be used as
odds ratios give an inflated impression of the size of effect in such
cases (Deeks). For continuous outcomes summary estimates will
be presented as weighted mean differences.
2
Were two or more studies have undertaken similar comparisons
using similar outcome measures they will be tested for
heterogeneity using Chi-square. Where clinical, methodological
and statistical heterogeneity is not apparent, similar studies
will be pooled using a fixed effects model. Where clinical and
methodological heterogeneity is absent, but there is statistical
heterogeneity, a random effects model will be applied. Where
pooling is not possible or appropriate trials will be discussed in a
narrative review.

POTENTIAL CONFLICT OF
INTEREST

None

ACKNOWLEDGEMENTS

We would like to thank Andrea Nelson and the Cochrane Wounds

Group, Jon Deeks and Pauline Pearson for their willingness to
share expertise and offer support during the formulation of this
review (protocol).

SOURCES OF SUPPORT

External sources of support

• No sources of support supplied

Internal sources of support
• University of Newcastle UK
• Royal College of Nursing Institute UK

REFERENCES

Dressing and topical agents for burns (Protocol) 3

Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Additional references
Addor
Addor V, Santos-Eggimann B. Population-based incidence of in-
juries among preschoolers. European Journal of Pediatrics 1996;155
(2):133–5.
Arturson
Arturson G. Management of burns. Proceedings from the First Eu-
ropean Conference on Advances in Wound Mangement. Macmillan,
1991.
Brigham
Brigham PA, McLoughlin E. Burn incidence and medical care use in
the United States: estimates, trends and data sources. Journal of Burn
Care Rehabilitation 1996;17(2):95–107.
Deeks
Deeks J. Odds ratios should be used only in case control studies and
logistic regression analyses. BMJ 1998;317:1155–6.
Home Office
Home Office. The Consumer Safety Unit. London: Department of
Trade and Industry, 1998:Department of Trade and Industry.
Lawrence
Lawrence CJ. A Century after Gamgee. Burns 1987;13:77–79.
Queen
Queen D, Evans JH, Gaylor JDS, Courtney JM, Reid WH. Burn
wound dressings - a review. Burns 1987;13(3):218–228.

COVER SHEET
Title Dressing and topical agents for burns
Authors Campbell F, Seers K
Contribution of author(s) Information not supplied by author
Issue protocol first published 2001/1
Date of most recent amendment 11 April 2003
Date of most recent 17 February 2000
SUBSTANTIVE amendment
What’s New Information not supplied by author
Contact address Mrs Fiona Campbell
Health Services Research
School of Population and Health Sciences
21 Claremont Place
Newcastle upon Tyne
NE2 4AA
UK
E-mail: fiona.campbell@ncl.ac.uk
Tel: + 44 191 222 5364
DOI 10.1002/14651858.CD002106
Cochrane Library number CD002106
Editorial group Cochrane Wounds Group
Editorial group code HM-WOUNDS
Dressing and topical agents for burns (Protocol) 4
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd