van Ramshorst Gabriëlle H, Vrijland Wietske, van der Harst Erwin, Hop Wim C J, den Hartog Dennis, Lange Johan F
Department of Surgery, Erasmus, University Medical Center, Rotterdam, The Netherlands; Email:
Wounds. 2010 Feb;22(2):38-43.
Abstract: Background. The use of digital photography to assess and document the wound healing process has become increasingly popular. One of the most common complications of wound healing is infection, but the validity of digital photography for the diagnosis of wound infection is unknown. We intended to measure the degree of inter and intra-observer agreement on the diagnosis of superficial wound infection using digital photography.
In a prospective, observational clinical study, abdominal wounds were photographed daily and signs of infection were documented in a standard manner. Four surgeons independently assessed photographs of 50 wounds opened for infection within hours after photography and 50 normally healed wounds (n = 50). Wound pain scores, morning temperature, and postoperative day were noted. Surgeons recorded the presence of infection and treatment for each wound. Paired kappa (κ) values were calculated and intra-observer agreement was measured after 4-6 weeks.
Mean specificity with regard to infection was 97% (94%-100%) and mean sensitivity was 42% (32%-48%). Paired κ-values with regard to wound infection were: 0.54, 0.67, 0.68, 0.63, 0.58, and 0.61. Agreement on treatment was present in 76 of 100 wounds (κ values: 0.15, 0.17, 0.20, 0.72, 0.63, 0.68). Kappa values for intra-observer agreement on infection were: 0.66, 0.43, 0.74, and 0.76 for surgeons A, B, C, and D, respectively.
Inter- and intra-observer agreement on the diagnosis of superficial infection with digital photography are moderate, but specificity is high. Physical examination findings should also be reported. .
摘要：背景。使用数码摄影来评估和记录伤口愈合过程越来越普遍。伤口愈合最常见的并发症之一是感染，但数码摄影用于诊断伤口感染的有效性尚不清楚。我们旨在测量使用数码摄影诊断浅表伤口感染时观察者间和观察者内的一致性程度。
在一项前瞻性观察性临床研究中，每天对腹部伤口进行拍照，并以标准方式记录感染迹象。四位外科医生独立评估了50例在拍照后数小时因感染而开放的伤口以及50例正常愈合伤口（n = 50）的照片。记录伤口疼痛评分、早晨体温和术后天数。外科医生记录每个伤口的感染情况和治疗方法。计算配对kappa（κ）值，并在4 - 6周后测量观察者内一致性。
关于感染的平均特异性为97%（94% - 100%），平均敏感性为42%（32% - 48%）。关于伤口感染的配对κ值分别为：0.54、0.67、0.68、0.63、0.58和0.61。100个伤口中有76个在治疗方面达成一致（κ值：0.15、0.17、0.20、0.72、0.63、0.68）。外科医生A、B、C和D在观察者内关于感染的一致性κ值分别为：0.66、0.43、0.74和0.76。
使用数码摄影诊断浅表感染时观察者间和观察者内的一致性为中等，但特异性较高。还应报告体格检查结果。
