Advice
The technology
The technology
moorLDLS‑BI (Moor Instruments Ltd) is a non‑invasive imaging system that uses laser doppler technology to map the blood flow in a burn. It uses an array of low‑power laser beams mounted on a scanning arm that moves across the area. The laser beam is directed using a mirror, which rotates to scan the burn wound. The mirror is between 10 cm and 20 cm from the wound, so there is no direct contact with the burned skin. Laser light scattered from moving blood cells in the tissue undergoes doppler frequency broadening. Some of the scattered laser light is focused onto photodiode detectors and the resulting photocurrents are processed. The amplitude of laser doppler signal is proportional to the average speed and the concentration of moving blood cells in the tissue. Results are displayed as a colour‑coded blood flow image and a colour video image of the burn wound. Healing potential results, based on the blood flow image, are calculated and reported in 3 categories: less than 14 days, 14 to 21 days and more than 21 days.
The moorLDLS‑BI system includes a scan head, scan controller and a touch‑screen panel computer. The system is mounted on a mobile stand that can be used in a ward, operating theatre or consulting room, as well as in rooms designed specifically for laser equipment. The system uses a class 3R laser, which is considered safe when handled carefully. The company notes that the risk of injury is relatively low for short and unintentional exposure, and the company can supply the product with protective eyewear.
moorLDLS‑BI may not be reliable for skin areas with tattoos because the laser light can be excessively absorbed. Identifying the level of burn injury can also be confounded by other factors such as oedema, tissue hypoxia and burn wound conversion.
Innovations
moorLDLS‑BI was developed using a line‑scanning approach to minimise scan time. The moorLDLS‑BI takes 4 seconds per scan. The maximum scan area for the moorLDLS‑BI is about 15 cm × 20 cm. For larger burn wounds multiple scans are needed. The company notes that moorLDLS‑BI is ideal for use in children because of its short scanning time and can also be used in adults who need repeat imaging to cover separate wounds or adjacent areas of large burns.
Current care pathway
In England and Wales burn care is organised using a tiered model of care outlined in the British Burn Association's National Burn Care Review. In this model of care, the most severely injured are cared for in recognised burn centres, while those needing less intensive clinical support are cared for in either burn units or burn facilities.
Clinical evaluation is the most widely used method of assessing burn wound depth and healing potential. This method is based on visual and tactile assessment of the external characteristics of the burn. The accuracy of clinical examination depends on the experience of the healthcare professional.
There is no NICE guideline on burn management, but NICE has published a medical technologies guidance on moorLDI2-BI: a laser doppler blood flow imager for burn wound assessment. The moorLDI2‑BI is a sister product of moorLDLS‑BI and is intended for larger burn area imaging (up to 50 cm × 50 cm). The guidance supports using moorLDI2‑BI in the NHS for guiding treatment for burn wounds with uncertain depth and healing potential.
Population, setting and intended user
The moorLDLS‑BI is intended for use by healthcare professionals to help evaluate people's burn wounds at specialist burn centres, 48 hours to 5 days after burns. The technology is not intended to be used as a standalone prediction for burn healing.
The company notes that there is potential for moorLDLS‑BI to be used outside specialist centres to aid referral decisions from burn units or facilities. The moorLDLS‑BI system can be used in the operating room, outpatient department, treatment or dressing rooms, or at the patient's bedside. The moorLDLS‑BI could help healthcare professionals decide whether early excision and graft surgery are needed.
Costs
Technology costs
The moorLDLS‑BI can be purchased at a cost of £63,421 with an annual servicing cost of about £6,145, or it can be leased at an inclusive cost of about £20,000 per year. The protective eyewear supplied by the company, for patient use, is included in the cost of the technology. Lifespan of the technology is around 10 years.
Costs of standard care
Clinical evaluation is the most widely used method of assessing burn wound depth. The hourly costs per person for burn clinical assessment in the NHS are £186 per clinician, and £105 per nurse per hour. The training cost covering 2 days (16 hours) training for 1 clinician, 2 registrars and 3 nurses is £5,160. Hospital stays are £387 per adult per day and £866 for per child. If surgery is needed, its cost is £2,319 per hour (NICE's medical technologies guidance on moorLDI2-BI).
Resource consequences
The moorLDLS‑BI is currently in use in 7 burn services in the NHS, including 5 services for children and 2 services for adults.
If the moorLDLS‑BI system is adopted in the NHS it would present an additional cost to standard care. If the use of the system is shown to have long‑term benefits such as improved wound‑assessment accuracy, then costs could be saved from improved wound healing by earlier decision making about treatment and reduced length of stay.