Nanocrystalline silver compared to alternative silver delivery systems in the management of burns
Reviewed by Kuen Y Chin

With the rapid pace of new medical products being developed and marketed, it can be difficult to identify which product will provide most benefit to our patients. It is essential to have good evidence to allow us to make the right choice. This systemic review and meta-analysis provides clinicians with current available evidence on the use nanocrystalline silver (ACTICOAT) compared to Silver Sulphodiazine (SSD) and silver nitrate preparations. Although 1587 papers were initially identified, 530 were removed due to duplication. A total of nine studies from the remaining 1057 met the inclusion criteria. The inclusion criteria was not described. Of these, four were randomised controlled trials, four retrospective studies and one consisted of a series of audits. The outcomes of interest are infection control, length of hospital stay, surgical procedures required by patients and pain reduction. Statistically significant shorter length of hospital stay, reduced number of required surgical procedures and lower reported pain scores were found in the nanocrystalline silver group compared to SSD and silver nitrate groups. Meta-analysis of randomised control trials (RCTs) that reported infection rates (two studies) did not show statistically significant difference between the nanocrystalline silver and SSD / silver nitrate groups. However, when the randomised control trials RCT and observational study data were pooled together, a statistically significant lower rate of infection was found in the nanocrystalline group. The reviewers acknowledge the paucity of high quality evidence available comparing nanocrystalline silver with other silver preparation for burns dressings. This study is beneficial for clinicians when trying to choose between silver-based dressings. In clinical practice, it is important to recognise the heterogeneity of individual patients presenting with burns, including patient factors and burn characteristics (e.g. depth, amount of exudate) and the cost of these dressings to help choose one that would be most appropriate for each patient.

A systematic review and meta-analysis of clinical outcomes associated with nanocrystalline silver use compared to alternative silver delivery systems in the management of superficial and deep partial thickness burns.
Nherera LM, Trueman P, Roberts CD, Berg L.
BURNS
2017;43(5):939-48.