Nakagami G, Sanada H, Iizaka S, Kadono T, Higashino T, Koyanagi H, Haga N
Department of Gerontological Nursing / Wound Care, the University of Tokyo, Tokyo, Japan.
J Wound Care. 2010 Nov;19(11):465-6, 468, 470 passim. doi: 10.12968/jowc.2010.19.11.79695.
To investigate whether thermography can be used to detect latent inflammation in pressure ulcers and predict pressure ulcer prognosis in a clinical setting.
For this cohort study, we recruited 35 patients with stage II-IV pressure ulcers on the torso, who underwent thermographic assessment on discovery of their pressure ulcer. The patients were followed up for at least 3 weeks. Thermography was performed immediately after dressing removal. Pressure ulcers were classified into two groups depending on whether or not the wound site temperature was lower or higher than the periwound skin: the low temperature group and the high temperature group respectively. A generalised estimation equation was used to estimate the relative risk of delayed healing of pressure ulcers, comparing wounds with high temperatures and low temperatures.
Of the 35 patients, 21 had 'low temperature' wounds and 14 had 'high temperature' wounds at baseline. Two patients in the high temperature group presented with overt infection, and were excluded from further analysis. Twenty-two pressure ulcers were considered to heal 'normally' (that is, the wound area reduced by 30% or more within 3 weeks) and 16 did not heal. The baseline DESIGN score (a measure of gross wound status) did not differ in any subscales between the high and low temperature groups. The relative risk for delayed healing in high temperature cases was 2.25 (95% confidence intervals; 1.13-4.47, p=0.021). Sensitivity was 0.56, specificity was 0.82, positive predictive value was 0.75, and negative predictive value was 0.67.
Our results indicate that using thermography to classify pressure ulcers according to temperature could be a useful predictor of healing at 3 weeks, even though wound appearances may not differ at the point of thermographical assessment. The higher temperature in the wound site, when compared with periwound skin, may imply the presence of critical colonisation, or other factors which disturb the wound healing.
探讨在临床环境中，热成像技术能否用于检测压疮中的潜在炎症并预测压疮预后。
在这项队列研究中，我们招募了35例躯干患有II-IV期压疮的患者，这些患者在发现压疮时接受了热成像评估。对患者进行了至少3周的随访。在去除敷料后立即进行热成像检查。根据伤口部位温度是否低于或高于伤口周围皮肤，将压疮分为两组：分别为低温组和高温组。使用广义估计方程来估计压疮延迟愈合的相对风险，比较高温伤口和低温伤口。
35例患者中，21例在基线时有“低温”伤口，14例有“高温”伤口。高温组中有2例出现明显感染，被排除在进一步分析之外。22个压疮被认为“正常”愈合（即伤口面积在3周内减少30%或更多），16个未愈合。高温组和低温组在任何子量表上的基线DESIGN评分（一种衡量伤口总体状况的指标）均无差异。高温病例延迟愈合的相对风险为2.25（95%置信区间：1.13-4.47，p=0.021）。敏感性为0.56，特异性为0.82，阳性预测值为0.75，阴性预测值为0.67。
我们的结果表明，尽管在热成像评估时伤口外观可能没有差异，但使用热成像技术根据温度对压疮进行分类可能是3周愈合情况的有用预测指标。与伤口周围皮肤相比，伤口部位温度较高可能意味着存在严重定植或其他干扰伤口愈合的因素。
