Use of Infrared Thermography for Assessment of Burn Depth and Healing Potential: A Systematic Review

Burn wound depth assessments are an important component of determining patient prognosis and making appropriate management decisions. Clinical appraisal of the burn wound by an experienced burn surgeon is standard of care but has limitations. Infrared (IR) thermography is a technology in burn care that can provide a noninvasive, quantitative method of evaluating burn wound depth. IR thermography utilizes a specialized camera that can capture the IR emissivity of the skin, and the resulting images can be analyzed to determine burn depth and healing potential of a burn wound. Though IR thermography has great potential for burn wound assessment, its use for this has not been well documented. Thus, we have conducted a systematic review of the current use of IR thermography to assess burn depth and healing potential. A systematic review and meta-analysis of the literature was performed on PubMed and Google Scholar between June 2020 and December 2020 using the following keywords: FLIR, FLIR ONE, thermography, forward looking infrared, thermal imaging + burn*, burn wound assessment, burn depth, burn wound depth, burn depth assessment, healing potential, burn healing potential. A meta-analysis was performed on the mean sensitivity and specificity of the ability of IR thermography for predicting healing potential. Inclusion criteria were articles investigating the use of IR thermography for burn wound assessments in adults and pediatric patients. Reviews and non-English articles were excluded. A total of 19 articles were included in the final review. Statistically significant correlations were found between IR thermography and laser Doppler imaging (LDI) in 4/4 clinical studies. A case report of a single patient found that IR thermography was more accurate than LDI for assessing burn depth. Five articles investigated the ability of IR thermography to predict healing time, with four reporting statistically significant results. Temperature differences between burnt and unburnt skin were found in 2/2 articles. IR thermography was compared to clinical assessment in five articles, with varying results regarding accuracy of clinical assessment compared to thermography. Mean sensitivity and specificity of the ability of IR thermography to determine healing potential <15 days was 44.5 and 98.8, respectively. Mean sensitivity and specificity of the ability of FLIR to determine healing potential <21 days was 51.2 and 77.9, respectively. IR thermography is an accurate, simple, and cost-effective method of burn wound assessment. FLIR has been demonstrated to have significant correlations with other methods of assessing burns such as LDI and can be utilized to accurately assess burn depth and healing potential. However, the technology needs more standardization and validation before it can achieve widespread adoption in clinical practice.