mHealth App for Pressure Ulcer Wound Assessment in Patients With Spinal Cord Injury: Clinical Validation Study

Abstract

Background Clinical evaluation of a pressure ulcer is based on quantitative and qualitative evaluation. In clinical practice, acetate tracing is the standard technique used to measure wound surface area; however, it is difficult to use in daily practice (because of material availability, data storage issues, and time needed to calculate the surface area). Planimetry techniques developed with mobile health (mHealth) apps can be used to overcome these difficulties. Objective The goal of this study was to evaluate the metrological properties of a free-access mHealth app, called imitoMeasure, to assess pressure ulcers. Methods This was a noninterventional, validation study. We included patients with spinal cord injury presenting with a pressure ulcer, regardless of its stage or location. We performed wound measurements with a ruler, and we performed acetate tracing using a transparent dressing with a wound measurement grid. Wound evaluation via the mHealth app was conducted twice by the main investigator and also by a coinvestigator to determine validity, intrarater reproducibility, and interrater reproducibility. Bland-Altman plots and intraclass correlation coefficients were used to compute the minimal detectable change percentage. Results Overall, 61 different pressure ulcers were included. The validity, intrarater reproducibility, and interrater reproducibility of the mHealth app vs acetate tracing (considered the method of reference) were good, with intraclass correlation coefficients of 0.97 (95% CI 0.93-0.99), 0.99 (95% CI 0.98-0.99), and 0.98 (95% CI 0.96-0.99), respectively, and minimal detectable change percentages between 17% and 35%. Conclusions The imitoMeasure app had good validity and reproducibility. It could be an alternative to standard wound assessment methods. Further studies on larger and more diverse wounds are needed. Trial Registration ClinicalTrials.gov NCT04402398; http://clinicaltrials.gov/ct2/show/NCT04402398

Infection Probability Index: Implementation of an Automated Chronic Wound Infection Marker

“…For this reason, parameters have been developed which can be applied to wounds of different sizes to detect infection because infection is independent of wound size. In addition, there are already some suitable systems for documenting the geometric dimensions of the wound [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. However, since this information does not provide information about a possible infection, it is important to aim for an additional broadest possible infection detection.…”

“…Based on the distance measurement of a depth camera, the limitation of the spacing in image detail between the visual and thermal images could be solved. By including a depth camera, the measurement of visual wound characteristics (e.g., wound size, shape) over time could also be possible [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The software foundation for this mobile system could be the algorithms proposed within this research as a proof of concept.…”

“…Other semi-quantitative systems address the contactless wound measurement. Planar, 2D images can form the basis to measure the wound’s width, height and area [ 23 , 24 ]. Moreover, there are multiple publications using contactless measurement to generate a 3D image of the wound to improve accuracy [ 25 , 26 , 27 , 28 ].…”

Reshaping wound care: Evaluation of an artificial intelligence app to improve wound assessment and management amid the COVID‐19 pandemic

“…Certain applications have algorithms and clinical decision‐support tools to assist in determining the best treatment options, the type of wound products to use, the tracking of the wound healing progression and the next steps to take. These technologies for wound care have been developed and used for a number of years in Europe, the United States, Canada and the United Kingdom 21‐24 . Their use is also understood to be in the Australian context; however, we could not identify any literature reporting digital apps for an extensive range of wound types.…”

“…These technologies for wound care have been developed and used for a number of years in Europe, the United States, Canada and the United Kingdom. 21 , 22 , 23 , 24 Their use is also understood to be in the Australian context; however, we could not identify any literature reporting digital apps for an extensive range of wound types. Some studies have reported single wound types such as diabetic foot ulcers.…”