Peterson N, Stevenson H, Sahni V
Mersey Deanery, Core Surgical Trainee, Lead Employer, Warrington Road, Prescot, Merseyside, L35 5DR, United Kingdom.
Injury. 2014 Jan;45(1):232-6. doi: 10.1016/j.injury.2012.04.018. Epub 2012 May 15.
The presentation of traumatic wounds is commonplace in the accident & emergency department. Often, these wounds need referral to specialist care, e.g. trauma & orthopaedic, plastic or maxillofacial surgeons. Documentation and communication of the size of the wound can influence management, e.g. Gustilo & Anderson classification of open fractures. Several papers acknowledge the variability in measurement of chronic wounds, but there is no data regarding accuracy of traumatic wound assessment. The authors hypothesised that the estimation of wound size and subsequent communication or documentation was often inaccurate, with high inter-observer variability. A study was designed to assess this hypothesis.
A total of 7 scaled images of wounds related to trauma were obtained from an Internet search engine. The questionnaire asked 3 questions regarding mechanism of injury, relevant anatomy and proposed treatment, to simulate real patient assessment. One further question addressed the estimation of wound size. 50 doctors of varying experience across several specialities were surveyed. The images were analysed after data collection had finished to provide appropriate measurements, and compared to the questionnaire results by a researcher blinded to the demographics of the individual.
Our results show that there is a high inter-observer variability and inaccuracy in the estimation of wound size. This inaccuracy was directional and affected by gender. Male doctors were more likely to overestimate the size of wounds, whilst their female colleagues were more likely to underestimate size.
The estimation of wound size is a common requirement of clinical practice, and inaccurate interpretation of size may influence surgical management. Assessment using estimation was inaccurate, with high inter-observer variability. Assessment of traumatic wounds that require surgical management should be accurately measured, possibly using photography and ruler measurement.
创伤性伤口在急诊科很常见。通常，这些伤口需要转诊至专科护理，例如创伤与骨科、整形外科或颌面外科医生处。伤口大小的记录和沟通会影响治疗管理，例如开放性骨折的 Gustilo & Anderson 分类。几篇论文承认慢性伤口测量存在差异，但尚无关于创伤性伤口评估准确性的数据。作者推测，伤口大小的估计以及随后的沟通或记录往往不准确，观察者间差异很大。为此设计了一项研究来评估这一假设。
通过互联网搜索引擎获取了 7 张与创伤相关的伤口缩放图像。问卷提出了 3 个关于受伤机制、相关解剖结构和建议治疗方法的问题，以模拟对真实患者的评估。还有一个问题涉及伤口大小的估计。对 50 名来自多个专科、经验各异的医生进行了调查。数据收集完成后，对图像进行分析以提供准确测量值，并由一名对个体人口统计学信息不知情的研究人员将其与问卷结果进行比较。
我们的结果表明，在伤口大小估计方面存在很高的观察者间差异和不准确性。这种不准确性具有方向性，且受性别影响。男医生更有可能高估伤口大小，而女同事则更有可能低估伤口大小。
伤口大小的估计是临床实践中的常见要求，对伤口大小的错误解读可能会影响手术管理。通过估计进行的评估不准确，观察者间差异很大。对于需要手术治疗的创伤性伤口，应使用摄影和直尺测量等方法进行准确测量。
