The use of telemedicine in burn care: development of a mobile system for TBSA documentation and remote assessment

Abstract

The requirements for accurate documentation within the process of burn assessment have increased dramatically over the years. TBSA (total body surface area) and burn depth are commonly determined by visual inspection, especially in the emergency or acute care setting. However, inexperience often results in incorrect estimation of these factors. In 2001, BurnCase 3D was initiated in order to develop a tool for objective burn assessment and documentation on mobile devices (Apple iPhoneTM). The centerpiece is a 3D model representing the actual patient. At two international burn meetings, a survey containing three pictures of patients was conducted and this data was collected. A patient-specific 3D model adapted to the height and weight of the real patient was created and the digital picture was superimposed in the computer system. The burns were transferred to the model and the TBSA in % was calculated by the software BurnCase 3D. The preferred methods of the 80 respondents for burn extent estimation were: the Rule of Nines (38%), the Rule of Palm (37%) and the Lund-Browder chart (18%). Analysis showed very high deviations of TBSA within the participants, even among the group of experts. In comparison to a computer-aided method we found massive overestimation of up to 230%. The use of BurnCase 3D could have a true impact on the quality of treatment in burns. In the acute care setting for burn injuries, telemedicine has great potential to help guide decisions regarding triage and transfer based on TBSA, burn depth, patient age and injury mechanism.

Keywords: BurnCase 3D; TBSA; application; burn injuries; telemedicine.

Fig. 1. Pictures of patients with different wound patterns depicted on the questionnaire: Patient 1 (2 years-of-age, male, 12 kg, 87 cm), Patient 2 (35 years-of-age, male, 80 kg, 182 cm), Patient 3 (4 years-of-age, female, 16 kg, 102 cm).

Fig. 2. Burn wound data transfer from superimposed picture to 3D model with “BurnCase 3D”. To archive an optimal result, the model was overlapped with the picture in three separate steps. The first picture shows the patient only, the second picture shows the overlapping for transferring the burns on head. The third and fourth picture shows the overlapping positions for transferring chest and arm. On the most right picture, the virtual model with all burns transferred is shown.

Table I. Results of patient 1 (2 years-of-age, male, 12kg, 87cm)

Table II. Results of patient 2 (35 years-of-age, male, 80kg, 182cm)

Table III. Results of patient 3 (4 years-of-age, female, 16kg, 102cm)

Fig. 3. Choosing an appropriate 3D standard model.

Fig. 4. The burned surface area can be marked manually on a 3D body surface by touchscreen interaction.

Fig. 5. BurnCase 3D incorporates the 12 most widely accepted TBSA estimation formulas in scientific.

Fig. 6. By specifying age, sex, height and weight and choosing an appropriate 3D standard model the system generates an automatically adapted virtual body surface, which accurately fits the patient’s individual body shape. Afterwards, a surface adaptation algorithm inflates the model until its TBSA exactly reaches the predicted value calculated by an established TBSA estimation formula.

Fig. 7. The integrated picture archive and alignment allow simple, fast, objective selection of TBSA-B and visual verification of acquired wound surfaces.