Cosmetic Surgery Research Today is a free monthly online journal that collates and summarizes the latest research about Cosmetic Surgery, including details on microsurgery, reconstruction, techniques, risks. | ||||||||
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The reliability of digital imaging in the remote assessment of wounds: defining a standard.Murphy RX, Bain MA, Wasser TE, Wilson E, Okunski WJ Division of Plastic and Reconstructive Surgery, Lehigh Valley Hospital, Allentown, PA 18105-1556, USA. sally.lutz@lvh.com CONTEXT: Telemedicine has been used for remote management of many medical problems. Given the ever-expanding demands to provide increasing service with increasingly limited resources, quality care and practice efficiency can be enhanced by telemedicine. OBJECTIVE: This study was undertaken to explore the reliability of wound assessment using computer-transmitted digital imagery compared with a traditional bedside evaluation and also to assess its potential role in healthcare delivery. DESIGN/SETTING/PATIENTS: In the hospital setting, rounding vascular surgeons and a surgical resident evaluated the wounds on the service. A digital photograph was obtained with a 3.3 megapixel camera, and a wound-assessment tool was completed. A plastic surgery attending then reviewed the images at a later date and completed the same data tool. MAIN OUTCOME MEASURES: Wounds were rated for eschar, exposed bone, cellulitis, purulence, swelling, granulation tissue, granulation color, and depth using a standardized data collection tool. kappa statistics were computed for all variables, between raters. RESULTS: There were 2 phases of the study. In both phases, there was 100% agreement by the rounding physicians that the digital image was representative of the wound. Phase 1 agreement between evaluators was moderate to almost perfect, as demonstrated by kappa values (range, 0.50-0.87). In phase 2, all variable kappa values were rated as almost perfect, except the ability to evaluate depth of the wound to the millimeter, which was rated as substantial. CONCLUSIONS: The ability to accurately evaluate a wound on the basis of a digital image is possible. However, it requires training of participants and is facilitated by use of an assessment tool. With these caveats, evaluation of wounds using digital images is equivalent to bedside examination. This technology can improve practice efficiency, provide needed expertise at remote sites, and is an acceptable alternative method of wound assessment. Published 24 March 2006 in Ann Plast Surg, 56(4): 431-6.
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