Wound Measurement Techniques Research Articles

Reliability of Wound Measurement Methods

Abstract: Reliable and accurate measurement methods are necessary for clinical assessment of wounds. Repeated measure of a wound indicates whether its healing is progressing or deteriorating, and if alternate treatment must be initiated. Many wound measurement techniques lack accuracy and reliability. Technology: We developed a software prototype that calculates 3-dimensional (3D) wound measurements from 3D scans. We conducted a study to compare the software prototype to physical and 2-dimensional (2D) image measurement techniques commonly used by clinicians. We compared inter-rater reliability between the techniques and measurements (i.e., length, width, depth, perimeter, surface area). Results: Inter-rater reliability was good or excellent for the physical, image, and software measurement techniques, however, there were significant differences in measurements between the techniques. For complex measurements (i.e., perimeter, surface area), the reliability of the software exceeded that of the physical and image techniques. Conclusions: Although inter-rater reliability was high for all measurement techniques, there was significant variability between the techniques. The software was overall most reliable, especially for calculation of complex measurements. Clinical Impact: Reducing the variability of wound measurements may improve patient outcomes, reduce the injury’s prevalence, and mitigate the associated morbidity, mortality, and costs of these occurrences.

Monitoring Wound Healing of Diabetic Foot Ulcers Using Two-Dimensional and Three-Dimensional Wound Measurement Techniques: A Prospective Cohort Study

Objective: Three-dimensional (3D) wound measurements enable the evaluation of wound healing from the wound bed, which may be a more sensitive measure than traditional two-dimensional (2D) area meas...

Vision based Pus Segmentation and Area Estimation of Wound using Android Application

The main intention of this paper is to eliminate the use of contact wound measurement techniques such as Ruler method, Graph method, Acetate method etc. These techniques, which are usually inaccurate and cumbersome, can cause pain and inconvenience to the patient. The paper mainly focuses on implementing and comparing various image processing and segmentation algorithms to get accurate measurements of the wounds. The second phase of our project concentrates on implementing these measurement algorithms on an android platform. The wound measurement application allows the patients to capture and assess their wounds from their home or work place. The application can be installed in almost all available smart phones.

Methods to assess area and volume of wounds - a systematic review.

Wound measurement is important in monitoring the healing process of chronic wounds and in evaluating the effect of treatment. The objective of this systematic review was to evaluate evidence from the literature on accuracy, agreement, reliability and feasibility of wound measurement techniques described since 1994. Studies were identified by searching the electronic databases PubMed, Embase and Cochrane Library. Of the 12 013 studies identified, 43 were included in the review. A total of 30 papers evaluated techniques for measuring wound area and 13 evaluated techniques for measuring wound volume. The six approaches for measuring wound area were simple ruler method (10 papers), mathematical models (5 papers), manual planimetry (10 papers), digital planimetry (16 papers), stereophotogrammetry (2 papers) and digital imaging method (20 papers). Of these studies, 10 evaluated accuracy, 15 agreement, 17 reliability and 25 mentioned feasibility. The number of wounds examined in the studies was highly variable (n = 3-260). Studies evaluating techniques for measuring wound volume included between 1 and 50 wounds and evaluated accuracy (4 studies), agreement (6 studies), reliability (8 studies) and feasibility (12 studies). Digital planimetry and digital imaging were considered the most accurate and reliable methods for area measurement, particularly in larger and irregularly shaped wounds. None of the three-dimensional technologies have so far had a major impact, because of their low accuracy, high cost and complexity in handling the system set-up.

Wound Measurement Techniques: Comparing the Use of Ruler Method, 2D Imaging and 3D Scanner

The statistics on the growing number of non-healing wounds is alarming. In the United States, chronic wounds affect 6.5 million patients. An estimated US $25 billion is spent annually on treatment of chronic wounds and the burden is rapidly growing due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide.1 Accurate wound measurement techniques will help health care personnel to monitor the wounds which will indirectly help improving care.7,9 The clinical practice of measuring wounds has not improved even today.2,3 A common method like the ruler method to measure wounds has poor interrater and intrarater reliability.2,3 Measuring the greatest length by the greatest width perpendicular to the greatest length, the perpendicular method, is more valid and reliable than other ruler based methods.2 Another common method like acetate tracing is more accurate than the ruler method but still has its disadvantages. These common measurement techniques are time consuming with variable inaccuracies. In this study, volumetric measurements taken with a non-contact 3-D scanner are benchmarked against the common ruler method, acetate grid tracing, and 2-D image planimetry volumetric measurement technique. A liquid volumetric fill method is used as the control volume. Results support the hypothesis that the 3-D scanner consistently shows accurate volumetric measurements in comparison to standard volumetric measurements obtained by the waterfill technique (average difference of 11%). The 3-D scanner measurement technique was found more reliable and valid compared to other three techniques, the ruler method (average difference of 75%), acetate grid tracing (average difference of 41%), and 2D planimetric measurements (average difference of 52%). Acetate tracing showed more accurate measurements compared to the ruler method (average difference of 41% (acetate tracing) compared to 75% (ruler method)). Improving the accuracy in measuring chronic wounds might improve overall care of patients with non-healing wounds. This study consistently shows that the 3-D scanner is a more accurate, quicker, and safer method for measuring wounds.

Iterative design and testing of a hand-held, non-contact wound measurement device

A variety of wound measurement techniques are available to clinicians. Options range from relatively simple and inexpensive to complex, expensive devices.An iterative design approach was used to evaluate and improve performance and clinical utility of a new wound measurement device (WMD). The design was based upon a commercially available Smartphone. Accuracy was assessed using bench testing and reliability of area measurements was determined using multiple evaluators. Clinical utility was investigated by deploying the WMD during wound rounds in a rehabilitation hospital.Accuracy testing revealed an average error <2% at 0° or skew and an average error of 4.28% at 10° of skew. The intra-rater reliability exceeded 0.975 for all raters and inter-rater reliability was 0.966. Clinical utility testing provided the opportunity to address several usability concerns including the software interface and computation times.The accuracy and reliability of a new, non-contact wound measurement device exceeded that of other manual techniques and were, at least, equivocal to other computer-based technologies. Some limitations of using a Smartphone were identified by the clinicians that can be addressed by the more advanced processing power of newer technology. Overall, the WMD was shown to have the potential as a useful clinical tool.

An Evaluation of Three Wound Measurement Techniques in Diabetic Foot Wounds

Approximately 80% of diabetes-related amputations are preceded by a diabetic foot ulcer (1,2). Wound measurement is an important component of successful wound management (3–6). Accurate identification of the wound margin and the calculation of wound area are crucial (7–9). Although more complex methods of wound measurement exist (planimetry, digitizing techniques, and stereophotogrammetry) (4,10–14), current practice focuses on wound measurement using simple ruler-based methods or by wound tracing. Ruler-based schemes tended to be less reliable in wounds >5 cm2 (11). Various mathematical formulae (including the calculation of area based on the formula for an ellipse) have been proposed to improve accuracy in wound surface area calculation in wounds <40 cm2 in size (10,11,15–17). The aim of this study was to evaluate and compare three wound measurement techniques: the Visitrak system (Smith and Nephew Healthcare, Hull, U.K.), a digital photography and image processing system (Analyze, version 6.0; AnalyzeDirect, Lenexa, KS), and an elliptical measurement method using the standard formula (πab) for the calculation of the area of an …

Reliability of Electronic Versus Manual Wound Measurement Techniques

Haghpanah S, Bogie K, Wang X, Banks PG, Ho CH. Reliability of electronic versus manual wound measurement techniques. Objective To compare the accuracy and reliability of 3 wound measurement techniques, including linear and 2 electronic techniques—Visitrak and the VeV MD system. Design Repeated measures involving forty 2-dimensional “wounds” with a range of clinically relevant sizes were created using regular paper. Blinded observers measured the surface areas of wounds in 2 sessions, using 3 techniques. Setting Research department of a tertiary referral center. Participants Four blinded observers. Interventions Not applicable. Main Outcome Measures Mixed linear models were fitted to determine interobserver and intraobserver variability. The average root mean square error (RMSE) for each measurement technique was determined to investigate the accuracy. Results Intraobserver variation was not significant in most measurement techniques. Interobserver variation was significant for all techniques. Linear measurements showed the highest RMSE, whereas VeV and Visitrak were comparable. Conclusions Reliability of repeated wound measurements for all techniques can be achieved only with the same observer. Linear measurement has the least accuracy in evaluating wound size, VeV is slightly better than Visitrak for large wounds, and Visitrak is slightly better than VeV for small wounds. Our study shows that the use of electronic devices is superior to manual techniques to achieve valid measurements of wound area.

Reliability of digital videometry and acetate tracing in measuring the surface area of cutaneous wounds

Purpose: The purpose of this study was to evaluate the reliability of digital videometry and acetate tracing in the measurement of cutaneous wound area. Methods: Four clinicians used both digital videometry and acetate tracing to measure five wounds that were artificially created on a cadaver specimen. In addition, the clinicians used an analog centimeter ruler to determine a rough estimate of the area of each wound. The wounds were measured a total of five times with each measurement instrument using a non-sequential repeat measures design. Associations between the three wound measurement techniques were examined with Pearson correlation coefficients. In addition, intraclass correlation coefficients (ICC) were calculated for each pair of the three measurement techniques. Results: Correlation between the measurement systems for all raters combined yielded Pearson r-values of 0.93 for ruler and acetate, 0.95 for ruler and digital and 0.97 for acetate and digital. Furthermore, the average measure ICC between acetate and digital was 0.94, between acetate and ruler was 0.76 and between digital and ruler was 0.57. Conclusion: These results suggest that wound area measurements obtained using digital videometry and acetate tracing are very similar and both techniques can be used interchangeably in either clinical or research settings.

MAVIS: a non-invasive instrument to measure area and volume of wounds

Accurate measurement of the physical size of wounds is vital for assessment of the progress of healing. An instrument has been developed to measure area and volume of skin wounds, ulcers, and pressure sores. MAVIS— Measurement of Area and Volume Instrument System—is based on the principle of colour coded structured light. A set of parallel stripes of alternating colours is projected onto the wound area at an angle of approximately 45° and is recorded by a CCD camera. From the known position of the focal points of projector and camera, and from the observed intersection points of the stripes of light with the wound surface, a computer calculates a three-dimensional map of the observed wound. The volume of the wound is defined as the volume of the region sandwiched between the observed surface and the original healthy skin surface which is simulated by cubic spline interpolation. This paper compares the performance of the instrument with three traditional wound measurement techniques using results obtained from a clinical trial involving 50 patients. Traditional area measurement techniques such as transparency tracings produce results with standard deviations between 4% (large wounds) and up to 20% (small wounds) of the measured mean value. MAVIS measurements reduce these standard deviations by 3–5%. Measuring the wound volume by alginate casts produces errors in volume figures between 5% and 40%. Standard deviations of MAVIS results are 5% smaller on average. The results demonstrate that MAVIS yields more reproducible results with a minimum of inter-observer error. The instrument does not make contact with the wound, provided visual records and measurements are made in less then 5 min. It is not suitable for undermined, very deep or very large wounds.

A practical framework for wound assessment. 2: Methods.

Accurate measurement and documentation of wound healing are essential if practitioners are to effectively evaluate the benefits of various treatment approaches. Increasingly, sophisticated wound measurement techniques are evolving, but many are impractical and costly. The physiology of healing and the relationship of each stage of this delicate process to the complex task of wound assessment were reviewed in part one of this article (Vol 5 (22): 1391-7) to help improve practitioners' clinical assessment skills. Part two will discuss ways in which the accuracy of simple, non-invasive measurement approaches may be improved so that overall alterations in wound dimension can be effectively monitored.

Measuring wounds.

A guide to the use of wound measurement techniques