{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T22:12:56Z","timestamp":1771539176468,"version":"3.50.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T00:00:00Z","timestamp":1609286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Enzymatic debridement (ED) has become a reliable tool for eschar removal. Although ED application is simple, wound bed evaluation and therapy decision post-intervention are prone to subjectivity and failure. Experience in ED might be the key, but this has not been proven yet. The aim of this study was to assess interrater reliability (IR) in post-intervention wound bed evaluation and therapy decision as well as the impact of experience. In addition, the authors introduce video assessment as a valuable tool for post-ED decision-making and education. A video-based survey was conducted among physicians with various experiences in ED. The survey involved multiple-choice and 5-point Likert scale questions about professional status, experience in ED, confidence in post-ED wound bed evaluation, and therapy decision. Subsequently, videos of 15 mixed pattern to full-thickness burns immediately after removal of the enzyme complex were demonstrated. Participants were asked for evaluation of each burn wound, including bleeding pattern and consequent therapy decision. IR \u2265 80% was considered as a consensus. Responses were stratified according to participants\u2019 experience in applying ED (&amp;lt;10, 10\u201319, 20\u201349, and \u226550 applications). IR was assessed by chi-square test (raw agreement [RA]; \u226580% was considered as a consensus) and by calculation of Krippendorff\u2019s alpha. In addition, expert consensus for therapy decision was compared with the actual clinical course of each shown patient. Last, participants were asked for their opinion on video as an assessment tool for post-ED wound bed evaluation, decision-making, and training. Thirty-one physicians from 11 burn centers participated in the survey. The overall consensus (raw agreement [RA] \u2265 80%) in post-ED wound bed evaluation and therapy decision was achieved in 20 and 40%, respectively. Krippendorff\u2019s alpha is given by 0.32 (95% confidence interval: 0.15, 0.49) and 0.31 (95% confidence interval: 0.16, 0.47), respectively. Subgroup analysis revealed that physicians with high experience in ED achieved significantly more consensus in post-intervention wound bed evaluation and therapy decision compared with physicians with moderate experience (60 vs 13.3%; P = .02 and 86.7 vs 33.3%; P = .04, respectively). Video analysis was considered a feasible (90.3%) and beneficial (93.5%) tool for post-intervention wound bed evaluation and therapy decision as well as useful for training purposes (100%). Reliability of wound bed evaluation and therapy decision after ED depends on the experience of the rating physician. Video analysis is deemed to be a valuable tool for ED evaluation, decision-making, and user training.<\/jats:p>","DOI":"10.1093\/jbcr\/iraa218","type":"journal-article","created":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T19:34:14Z","timestamp":1609356854000},"page":"953-961","source":"Crossref","is-referenced-by-count":15,"title":["Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision"],"prefix":"10.1093","volume":"42","author":[{"given":"Laura C","family":"Siegwart","sequence":"first","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arne H","family":"B\u00f6cker","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannick F","family":"Diehm","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitra","family":"Kotsougiani-Fischer","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella","family":"Erdmann","sequence":"additional","affiliation":[{"name":"Institute for Medical Biometry and Informatics, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Ziegler","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Kneser","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Hirche","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Fischer","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen, Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, Hand and Plastic Surgery, University of Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,12,30]]},"reference":[{"key":"2021093015223764300_CIT0001","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.burns.2004.04.010","article-title":"Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report","volume":"30","author":"Rosenberg","year":"2004","journal-title":"Burns"},{"key":"2021093015223764300_CIT0002","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.burns.2013.08.013","article-title":"A novel rapid and selective enzymatic debridement agent for burn wound management: a 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