Table 6, Summary of Findings of Included Primary Clinical Study - Cooling for Thermal Burns: Clinical Effectiveness and Guidelines

Main Study Findings	Authors’ Conclusion
Wood 2016⁸
Cooling: 68% patients received cooling prior to admission 46% of these patients received cooling for at least 20 minutes 97% of these patients received cooling within three hours of injury Patient related outcomes: Graft surgery 13% reduction in probability of graft surgery associated with cooling (from 0.537 to 0.070, p=0.014) Probability increases linearly with increasing age and TBSA (OR=1.06, 95% CI 1.00 to 1.11, p=0.032) The benefit of water first aid is greater in burns with smaller TBSA (water first aid and TBSA interact, OR=1.04, 95% CI 1.01 to 1.07, p=0.003) In-hospital mortality Association with cooling (OR=0.77, p=0.013) Significant linear association with TBSA (OR=1.09, 95% CI 1.05 to 1.13, p<0.001) The benefit of water first aid is greater at older ages (water first aid and age interact, OR=1.03, 95% CI 1.002 to 1.06, p=0.035) Health system (cost) outcomes: Total hospital OR = Odds Ratio, CI = Confidence Interval, LOS in days 18% reduction in probability of LOS associated with cooling from (from 12.9 to 10.63 days, p=0.001) Probability increases non-linearly with increasing TBSA (mean standardized TBSA OR=0.358, 95% CI 0.268 to 0.449, p<0.001, spline transformation 1 OR=1.60, 95% CI 1.24 to 1.96, p<0.001, spline transformation 2 OR=-0.049, 95% CI −0.118 to 0.021, p=0.170) After water first aid, burns with larger TBSA result in longer OR = Odds Ratio, CI = Confidence Interval, LOS (OR=0.20, 95% CI 0.008 to 0.032, p=0.001) Admission to ICU 48% reduction in probability of ICU admission associated with cooling (0.175 from to 0.084, p<0.001) Probability increases non-linearly with increasing TBSA (mean standardized TBSA OR=2.26, 95% CI 1.84 to 2.78, p<0.001, spline transformation OR=1.32, 95% CI 1.15 to 1.51, p<0.001) The benefit of water first aid is greater in burns with smaller TBSA and, especially, medium TBSA (water first aid and TBSA interact, OR=1.03, 95% CI 0.999 to 1.06, p=0.062) “All outcomes except death showed a dose-response relationship with the duration of first aid.” (p. 2)	“This study suggests that there are significant patient and health system benefits from cooling water first aid, particularly if applied for up to 20 minutes. The results of this study estimate the effect size of post-burn first aid and confirm that efforts to promote first aid knowledge are not only warranted, but provide potential cost savings.” (p. 2) “This study has confirmed the magnitude of benefit from first aid after burn and emphasised the parameters of water cooling to achieve a significantly reduced need for surgical intervention, length of stay and ICU admission. Further studies with a larger dataset are needed to confirm or refute the association with risk of death.” (p. 12)

Main Study Findings

Authors’ Conclusion

Wood 2016⁸

Cooling:

68% patients received cooling prior to admission
- 46% of these patients received cooling for at least 20 minutes
- 97% of these patients received cooling within three hours of injury

Patient related outcomes:

Graft surgery
- 13% reduction in probability of graft surgery associated with cooling (from 0.537 to 0.070, p=0.014)
- Probability increases linearly with increasing age and TBSA (OR=1.06, 95% CI 1.00 to 1.11, p=0.032)
- The benefit of water first aid is greater in burns with smaller TBSA (water first aid and TBSA interact, OR=1.04, 95% CI 1.01 to 1.07, p=0.003)
In-hospital mortality
- Association with cooling (OR=0.77, p=0.013)
- Significant linear association with TBSA (OR=1.09, 95% CI 1.05 to 1.13, p<0.001)
- The benefit of water first aid is greater at older ages (water first aid and age interact, OR=1.03, 95% CI 1.002 to 1.06, p=0.035)

Health system (cost) outcomes:

Total hospital OR = Odds Ratio, CI = Confidence Interval, LOS in days
- 18% reduction in probability of LOS associated with cooling from (from 12.9 to 10.63 days, p=0.001)
- Probability increases non-linearly with increasing TBSA (mean standardized TBSA OR=0.358, 95% CI 0.268 to 0.449, p<0.001, spline transformation 1 OR=1.60, 95% CI 1.24 to 1.96, p<0.001, spline transformation 2 OR=-0.049, 95% CI −0.118 to 0.021, p=0.170)
- After water first aid, burns with larger TBSA result in longer OR = Odds Ratio, CI = Confidence Interval, LOS (OR=0.20, 95% CI 0.008 to 0.032, p=0.001)
Admission to ICU
- 48% reduction in probability of ICU admission associated with cooling (0.175 from to 0.084, p<0.001)
- Probability increases non-linearly with increasing TBSA (mean standardized TBSA OR=2.26, 95% CI 1.84 to 2.78, p<0.001, spline transformation OR=1.32, 95% CI 1.15 to 1.51, p<0.001)
- The benefit of water first aid is greater in burns with smaller TBSA and, especially, medium TBSA (water first aid and TBSA interact, OR=1.03, 95% CI 0.999 to 1.06, p=0.062)

“All outcomes except death showed a dose-response relationship with the duration of first aid.” (p. 2)

“This study suggests that there are significant patient and health system benefits from cooling water first aid, particularly if applied for up to 20 minutes. The results of this study estimate the effect size of post-burn first aid and confirm that efforts to promote first aid knowledge are not only warranted, but provide potential cost savings.” (p. 2)

“This study has confirmed the magnitude of benefit from first aid after burn and emphasised the parameters of water cooling to achieve a significantly reduced need for surgical intervention, length of stay and ICU admission. Further studies with a larger dataset are needed to confirm or refute the association with risk of death.” (p. 12)

From: Cooling for Thermal Burns: Clinical Effectiveness and Guidelines

Cover of Cooling for Thermal Burns: Clinical Effectiveness and Guidelines

Cooling for Thermal Burns: Clinical Effectiveness and Guidelines [Internet].

Sutton D, Wright MD.

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jan 17.

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Table 6Summary of Findings of Included Primary Clinical Study