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Burn dressings

Question Type:
Intervention
Full Question:
Among adults and children with thermal injuries (P), does the use of a wet dressing (I), compared with dry dressing (C), change complications, pain, tissue healing, need for advanced medical care, patient satisfaction, rates of fasciotomy (O)?
Consensus on Science:
There are no studies directly evaluating wet versus dry dressings in the first aid context. All studies were performed in a healthcare professional setting, and caution should be used in generalizing findings to the first aid situation. For the critical outcome of complications (infection), we identified low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from 1 RCT enrolling 104 subjects with superficial burns(Subrahmanyam 1991, 497) showing benefit with application of honey compared with silver sulfadiazine–impregnated gauze dressings, with resolution of infection at 7 days (RR, 12.40; 95% CI, 4.15–37.00). A second RCT enrolling 100 patients with partial thickness burns(Subrahmanyam 1996, 491) found benefit with application of honey compared with potato peel dressings, with resolution of infection at 7 days (absolute risk reduction, 0.90; 95% CI, 0.74–0.95). We also identified very-low-quality evidence (downgraded for risk of bias and imprecision) from a non-RCT(Heinrich 1988, 253) with 262 enrolled patients with partial thickness burns of less than 15% total body surface area, evaluating the difference in infection rates with a topical, nonpenetrating antibacterial agent (Polysporin, wet; n=102), a topical, penetrating antibacterial agent (silver sulfadiazine, wet; n=58), and a petrolatum gauze dressing (Xeroform, dry; n=112). This study showed no statistically significant difference in infection rate for the silver sulfadiazine wet dressings compared with the dry Xeroform dressing or for the Polysporin wet dressing compared with the dry Xeroform dressing. For the critical outcome of complications (hypergranulation tissue, postburn contracture, or hypertrophic scar), we identified low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from 1 RCT(Subrahmanyam 1991, 497) showing benefit for honey dressings compared with silver sulfadiazine–impregnated gauze dressings (RR, 0.13; 95% CI, 0.03–0.52). For the important outcome of tissue healing, we identified low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from 1 RCT(Subrahmanyam 1991, 497) showing benefit with honey (wet) compared with (dry) silver sulfadiazine–impregnated gauze dressing. This study enrolled 104 subjects and showed a decreased mean duration of time to healing when a honey dressing was used (MD, −7.80; 95% CI, −8.78 to −6.63). In addition, further low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from 1 RCT(Subrahmanyam 1996, 491) enrolling 100 subjects also showed a decreased mean duration of time to healing with honey (wet) compared with (dry) potato peel dressings (MD, −5.80; 95% CI, −6.68 to −4.92). We did not identify any evidence to address the important outcome of pain and the less important outcomes of need for advanced medical care, patient satisfaction, and rates of fasciotomy.
Treatment Recommendation:
No recommendation; there is insufficient evidence to show any benefits of wet compared with dry dressings applied to thermal burns in the prehospital setting. Values, Preferences, and Task Force Insights Studies included in this review evaluated out-of-hospital use of dressings and assumed that cooling had taken place before a dressing was applied. Public comment was made about the use of plastic wrap for burns. Plastic wrap (a dry dressing) was included in the search strategy, but no comparative studies to a wet dressing were identified.
CoSTR Attachments:
ILCORSlideTemplate.Dallas2015.plenary and TF. 1.7.18 Burn Dressings final 1-18.ppt    

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