Oropallo Alisha R, Andersen Charles, Abdo Raymond, Hurlow Jenny, Kelso Martha, Melin Mark, Serena Thomas E
Comprehensive Wound Healing Center and Hyperbarics, Department of Vascular Surgery, Zucker School of Medicine Hofstra/Northwell, Hempstead, NY 11549, USA.
Wound Care Clinic, Madigan Army Medical Center Joint Base Lewis-McChord, Renton, WA 98431, USA.
Diagnostics (Basel). 2021 Jul 6;11(7):1219. doi: 10.3390/diagnostics11071219.
Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point--of--care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.
细菌水平过高会阻碍伤口愈合，并可能导致感染性并发症。不幸的是，细菌负荷升高的临床体征和症状往往不可靠。因此，用于检测伤口中关键细菌负荷的即时荧光成像，正作为伤口评估方案中一个被认可的补充组成部分，在全球范围内被临床医生广泛认可和采用。采用德尔菲法建立了描述荧光成像使用的共识指南。一个由32名伤口专家组成的多学科小组（56%为医学博士，22%为足病医生，12.5%为护士/执业护士）代表多个服务场所（如医院门诊、住院部、私人诊所、长期护理机构）完成了两轮在线问卷调查。德尔菲法涵盖了关键主题，包括进行成像所需的能力、成像的临床指征（如出现的体征/症状、需要成像的程序）、成像频率以及临床工作流程算法。在描述成像影响的临床经验时，超过80%的人报告治疗计划有变化，96%的人报告基于成像的治疗计划使伤口愈合得到改善，78%的人报告截肢率降低，83%的人报告微生物采样率降低。这里提供的指南将有助于规范伤口护理人员对荧光成像的使用，并提高患者护理质量。
