Wang Sheila C, Anderson John A E, Evans Robyn, Woo Kevin, Beland Benjamin, Sasseville Denis, Moreau Linda
Department of Medicine, Division of Dermatology, McGill University, Montreal, Quebec, Canada.
Department of Psychology, York University, Toronto, Ontario, Canada.
PLoS One. 2017 Aug 17;12(8):e0183139. doi: 10.1371/journal.pone.0183139. eCollection 2017.
Current wound assessment practices are lacking on several measures. For example, the most common method for measuring wound size is using a ruler, which has been demonstrated to be crude and inaccurate. An increase in periwound temperature is a classic sign of infection but skin temperature is not always measured during wound assessments. To address this, we have developed a smartphone application that enables non-contact wound surface area and temperature measurements. Here we evaluate the inter-rater reliability and accuracy of this novel point-of-care wound assessment tool.
The wounds of 87 patients were measured using the Swift Wound app and a ruler. The skin surface temperature of 37 patients was also measured using an infrared FLIR™ camera integrated with the Swift Wound app and using the clinically accepted reference thermometer Exergen DermaTemp 1001. Accuracy measurements were determined by assessing differences in surface area measurements of 15 plastic wounds between a digital planimeter of known accuracy and the Swift Wound app. To evaluate the impact of training on the reproducibility of the Swift Wound app measurements, three novice raters with no wound care training, measured the length, width and area of 12 plastic model wounds using the app. High inter-rater reliabilities (ICC = 0.97-1.00) and high accuracies were obtained using the Swift Wound app across raters of different levels of training in wound care. The ruler method also yielded reliable wound measurements (ICC = 0.92-0.97), albeit lower than that of the Swift Wound app. Furthermore, there was no statistical difference between the temperature differences measured using the infrared camera and the clinically tested reference thermometer.
The Swift Wound app provides highly reliable and accurate wound measurements. The FLIR™ infrared camera integrated into the Swift Wound app provides skin temperature readings equivalent to the clinically tested reference thermometer. Thus, the Swift Wound app has the advantage of being a non-contact, easy-to-use wound measurement tool that allows clinicians to image, measure, and track wound size and temperature from one visit to the next. In addition, this tool may also be used by patients and their caregivers for home monitoring.
目前的伤口评估方法在多个方面存在不足。例如，测量伤口大小最常用的方法是使用尺子，事实证明这种方法粗糙且不准确。伤口周围温度升高是感染的典型迹象，但在伤口评估过程中并不总是测量皮肤温度。为了解决这个问题，我们开发了一款智能手机应用程序，可实现非接触式伤口表面积和温度测量。在此，我们评估这款新型即时护理伤口评估工具的评分者间信度和准确性。
使用Swift Wound应用程序和尺子对87例患者的伤口进行测量。还使用与Swift Wound应用程序集成的红外FLIR™相机以及临床认可的参考温度计Exergen DermaTemp 1001测量了37例患者的皮肤表面温度。通过评估已知精度的数字平面仪与Swift Wound应用程序对15个塑料伤口表面积测量值的差异来确定准确性测量。为了评估培训对Swift Wound应用程序测量可重复性的影响，三名未接受伤口护理培训的新手评分者使用该应用程序测量了12个塑料模型伤口的长度、宽度和面积。在不同伤口护理培训水平的评分者中，使用Swift Wound应用程序均获得了较高的评分者间信度（组内相关系数ICC = 0.97 - 1.00）和较高的准确性。尺子测量方法也得出了可靠的伤口测量结果（ICC = 0.92 - 0.97），尽管低于Swift Wound应用程序。此外，使用红外相机和临床测试参考温度计测量的温度差异无统计学差异。
Swift Wound应用程序提供了高度可靠和准确的伤口测量结果。集成到Swift Wound应用程序中的FLIR™红外相机提供的皮肤温度读数与临床测试参考温度计相当。因此，Swift Wound应用程序具有非接触、易于使用的伤口测量工具的优势，使临床医生能够在每次就诊时对伤口进行成像、测量和跟踪伤口大小及温度。此外，患者及其护理人员也可使用此工具进行家庭监测。
