Predictor of Burn Wound Conversion as a Reference for Conservative and Operative Management: Review of Imagej, Flir One® And Development Of A Risk Actor Score Model.

Burn wound conversion describes the process by which superficial-partial thickness burns convert into deeper burns within 3-7 days after burn. Autophagy, inflammation, ischemia, infection and reactive oxygen species are thought to have a role in pathogenesis of burn wound conversion. This study aims to assess risk factors for burn conversion and develop a scoring system to predict it. The study was conducted using nested case control method, in burn patients treated in Dr. Cipto Mangunkusumo Hospital and Jakarta Islamic Hospital Cempaka Putih. Subjects were recruited by consecutive sampling in February 2019-August 2020. The role of clinical characteristics, local and systemic examination as predictors of burn wound conversion were assessed. Risk factors were analysed using bivariate and multivariate analysis. There were 40 subjects in the case group and 20 subjects in the control group. Involvement of trunk, limbs, burn extent measured using ImageJ, ≥ 9.49%TBSA, wound surface temperature measured using Flir one^® thermography ≤ -1.55°C, procalcitonin level ≥ 0.075 ng/mL, and blood lactate level ≥ 1.75 mmol/L had a significant relationship with burn wound conversion. Three scoring models were developed: model 1 to be applied in tertiary health facilities, and model 2 and 3 to be applied in primary and secondary health facilities with sensitivity and specificity of 92.5% and 85%, 95% and 70% and 92.5% and 85%, respectively. The scoring models can be used in daily practice, especially as a reference for conservative and operative management.