Size matters: how accurate is clinical estimation of traumatic wound size?

AIMS

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.