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

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Abstract

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.

Introduction

Wound healing research requires an accurate and reproducible method to assess wound size. In addition, clinical care of chronic wounds can benefit from routine assessment of wound size, in order to evaluate the efficacy of treatment regimens. For both medical scientists and clinicians, the technique of choice is often indirect measurement of wound surface area by tracing the perimeter of intact epidermis onto a sheet of clear plastic. Carrel and Hartmann first described this technique in 1916 [1]. The area inside the tracing can then be quantified by overlaying the tracing on grid paper. Alternatively, the plastic itself can be imprinted with a precise grid. By counting the number of squares (whose area is known) that are contained inside the tracing, an acceptably accurate area measurement can be obtained. Several authors [2], [3], [4], [5] have established the reliability and cost-effectiveness of this technique.

With the increasing popularity of computers in medical practice, several companies have developed computer-assisted wound measurement systems. Computers have been used to analyze photographic wound images, direct wound tracings and structured light deformations as a means to assess wound surface area and/or volume. These myriad techniques have all met with an acceptable level of reliability [3], [4], [6], [7], [8], [9], [10], [11], [12]. Recently, computer-assisted wound measurement systems, which use non-proprietary hardware and run the Windows ’95 operating system, have become commercially available. While these systems are increasing in popularity, their reliability in assessing wound surface area has not been established in the literature. Therefore, the purpose of this study was to compare digital videometry to standard acetate tracing in order to determine if measurements obtained using these techniques are statistically similar.

Section snippets

Materials and methods

This prospective study utilized four clinician raters. Using a repeated measures design, each rater measured the surface area of five wounds using three measurement techniques. The wounds were of various shapes and sizes and were artificially created on cadaver specimens with the use of a #10 scalpel blade. Prior to measuring the wounds, the raters were given a 30-min training session on the proper technique to use when measuring the wounds. The training session was given to all raters at the

Results

The mean areas of each of the five wounds after a total of 20 measurements (five measurements by each of four clinician raters) are presented in Fig. 3. 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. Correlations between measurement systems for each rater individually are summarized in Table 1. Repeated measures of ANOVA were each statistically significant

Discussion

The results of this study suggest that wound measurements obtained using digital videometry and those obtained by acetate tracing are very similar. When taking into account the strength of agreement relative to variability, acetate tracing and digital videometry showed the best correlation of any two techniques tested (ICC=0.94). Either technique could be used with confidence in a research or clinical setting. The measurements obtained using the ruler did not correlate well with either acetate

Acknowledgements

The authors would like to thank Robert Wood, S. Khalid Husain, and Susan Stacpoole-Shea for their assistance in this project.

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