Table.
GRADE Evaluation of interventions for Burns: dressings.
| Important outcomes | Healing, Investigator/participant preference and satisfaction, Symptom severity | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of treatments for partial-thickness burns? | |||||||||
| 1 (59) | Healing | Alginate dressings versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of reporting on blinding, weak methods (randomisation/ allocation) |
| 1 (72) | Healing | Biosynthetic dressing versus hydrocolloid dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, and weak methods (unclear randomisation/allocation) |
| 1 (72) | Symptom severity | Biosynthetic dressing versus hydrocolloid dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, and weak methods (unclear randomisation/allocation) |
| 3 (approx 253) | Healing | Biosynthetic dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for no or unclear blinding, incomplete reporting of results in 2 trials, and weak methods (unclear randomisation/allocation) |
| 3 (approx 126) | Symptom severity | Biosynthetic dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, no or unclear blinding, and weak methods (unclear randomisation/allocation in 1 trial; patients acting as own control in 1 trial) |
| 2 (77) | Healing | Antimicrobial-releasing biosynthetic dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, and weak methods (unclear randomisation/allocation/intra-individual comparisons) |
| 1 (50) | Investigator/participant preference and satisfaction | Antimicrobial-releasing biosynthetic dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, and weak methods (unclear randomisation/allocation/patients used as own control) |
| 1 (34) | Healing | Chlorhexidine-impregnated paraffin gauze dressing versus hydrocolloid dressing plus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, weak methods (randomisation/allocation), and no statistical analysis between groups |
| 1 (34) | Healing | Hydrocolloid dressing versus chlorhexidine-impregnated paraffin gauze dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, incomplete reporting of results, and weak methods (randomisation/allocation) |
| 1 (42) | Healing | Hydrocolloid dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, no blinding, incomplete reporting of results, and weak methods (randomisation/allocation) |
| 1 (42) | Symptom severity | Hydrocolloid dressing versus silver sulfadiazine cream | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data, no blinding, and weak methods (randomisation/allocation); directness point deducted for unclear outcome |
| 1 (42) | Investigator/participant preference and satisfaction | Hydrocolloid dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, no blinding, incomplete reporting of results, and weak methods (randomisation/allocation) |
| 2 (127) | Healing | Hydrogel dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and incomplete reporting of results |
| 1 (47) | Symptom severity | Hydrogel dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and incomplete reporting of results |
| 2 (unclear) | Healing | Hydrogel dressing versus standard treatment | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, patients acting as own control, and incomplete reporting of results |
| 2 (unclear) | Symptom severity | Hydrogel dressing versus standard treatment | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, patients acting as own control, and incomplete reporting of results |
| 2 (152) | Healing | Hydrogel fibre dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and weak methods in 1 trial (randomisation/allocation unclear) |
| 2 (152) | Symptom severity | Hydrogel fibre dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and weak methods in 1 trial (randomisation/allocation unclear) |
| 1 (55) | Healing | Polyurethane film versus paraffin gauze dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and incomplete reporting of results |
| 1 (55) | Symptom severity | Polyurethane film versus paraffin gauze dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and incomplete reporting of results |
| 1 (55) | Investigator/participant preference and satisfaction | Polyurethane film versus paraffin gauze dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and incomplete reporting of results |
| 1 (51) | Healing | Polyurethane film versus chlorhexidine-impregnated paraffin gauze dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, incomplete reporting of results, and weak methods (randomisation/allocation) |
| 1 (51) | Symptom severity | Polyurethane film versus chlorhexidine-impregnated paraffin gauze dressing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, incomplete reporting of results, and weak methods (randomisation/allocation) |
| 2 (139) | Healing | Silicone-coated nylon dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and weak methods (randomisation/allocation) |
| 1 (63) | Symptom severity | Silicone-coated nylon dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, and weak methods (randomisation/allocation) |
| 7 (unclear) | Healing | Silver-impregnated dressing versus silver sulfadiazine cream | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for no or unclear blinding, weak methods in 4 RCTs (unclear randomisation/ allocation, reporting on wounds rather than people, incomplete reporting of results); directness point deducted for 1 RCT studying delayed rather than acute treatment and use of variety of types of dressings impregnated with silver |
| 5 (227) | Symptom severity | Silver-impregnated dressing versus silver sulfadiazine cream | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for unclear blinding and weak methods (unclear randomisation/ allocation); directness point deducted for use of variety of types of dressings impregnated with silver |
| 1 (24) | Investigator/participant preference and satisfaction | Silver-impregnated dressing versus silver sulfadiazine cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, and weak methods (unclear randomisation/ allocation) |
| 1 (128) | Healing | Silver-impregnated dressings versus Vaseline® covered with gauze | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, and weak methods (unclear randomisation/ allocation) |
| 1 (32) | Healing | Silver sulfadiazine cream plus hydrocolloid dressing versus hydrocolloid dressing alone | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear blinding, incomplete reporting of results, and weak methods (randomisation/allocation) |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.