Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore.
Int Wound J. 2022 Jan;19(1):114-124. doi: 10.1111/iwj.13603. Epub 2021 May 4.
There is a lifetime risk of 15% to 25% of development of diabetic foot ulcers (DFUs) in patients with diabetes mellitus. DFUs need to be followed up on and assessed for development of complications and/or resolution, which was traditionally performed using manual measurement. Our study aims to compare the intra- and inter-rater reliability of an artificial intelligence-enabled wound imaging mobile application (CARES4WOUNDS [C4W] system, Tetsuyu, Singapore) with traditional measurement. This is a prospective cross-sectional study on 28 patients with DFUs from June 2020 to January 2021. The main wound parameters assessed were length and width. For traditional manual measurement, area was calculated by overlaying traced wound on graphical paper. Intra- and inter-rater reliability was analysed using intra-class correlation statistics. A value of <0.5, 0.5-0.75, 0.75-0.9, and >0.9 indicates poor, moderate, good, and excellent reliability, respectively. Seventy-five wound episodes from 28 patients were collected and a total of 547 wound images were analysed in this study. The median wound area during the first clinic consultation and all wound episodes was 3.75 cm (interquartile range [IQR] 1.40-16.50) and 3.10 cm (IQR 0.60-14.84), respectively. There is excellent intra-rater reliability of C4W on three different image captures of the same wound (intra-rater reliability ranging 0.933-0.994). There is also excellent inter-rater reliability between three C4W devices for length (0.947), width (0.923), and area (0.965). Good inter-rater reliability for length, width, and area (range 0.825-0.934) was obtained between wound nurse measurement and each of the C4W devices. In conclusion, we obtained good inter-rater and intra-rater reliability of C4W measurements against traditional wound measurement. The C4W is a useful adjunct in monitoring DFU wound progress.
在糖尿病患者中，发生糖尿病足溃疡（DFU）的终生风险为 15%至 25%。DFU 需要进行随访和评估以了解并发症的发展情况和/或是否愈合，传统上是通过手动测量来进行。我们的研究旨在比较人工智能支持的伤口成像移动应用程序（CARES4WOUNDS [C4W] 系统，Tetsuyu，新加坡）与传统测量方法的内部和外部评估者之间的可靠性。这是一项 2020 年 6 月至 2021 年 1 月期间对 28 例 DFU 患者进行的前瞻性横断面研究。评估的主要伤口参数为长度和宽度。对于传统的手动测量，通过将跟踪的伤口叠加在图形纸上计算面积。使用组内相关统计数据分析内部和外部评估者之间的可靠性。<0.5、0.5-0.75、0.75-0.9 和>0.9 分别表示可靠性差、中等、良好和优秀。本研究共收集了 28 例患者的 75 个伤口发作，共分析了 547 个伤口图像。首次就诊时和所有伤口发作期间的中位伤口面积分别为 3.75 cm（四分位距 [IQR] 1.40-16.50）和 3.10 cm（IQR 0.60-14.84）。C4W 在同一张伤口的三次不同图像采集上具有极好的内部评估者可靠性（内部评估者可靠性范围为 0.933-0.994）。对于长度（0.947）、宽度（0.923）和面积（0.965），三个 C4W 设备之间也具有极好的外部评估者可靠性。在与每个 C4W 设备的伤口护士测量相比，长度、宽度和面积的外部评估者可靠性也较好（范围为 0.825-0.934）。总之，我们发现 C4W 测量与传统伤口测量之间具有良好的外部评估者和内部评估者可靠性。C4W 是监测 DFU 伤口进展的有用辅助工具。
