Remote assessment of diabetic foot ulcers using a novel wound imaging system

Abstract

Telemedicine allows experts to assess patients in remote locations, enabling quality convenient, cost-effective care. To help assess foot wounds remotely, we investigated the reliability of a novel optical imaging system employing a three-dimensional camera and disposable optical marker. We first examined inter- and intraoperator measurement variability (correlation coefficient) of five clinicians examining three different wounds. Then, to assess of the system's ability to identify key clinically relevant features, we had two clinicians evaluate 20 different wounds at two centers, recording observations on a standardized form. Three other clinicians recorded their observations using only the corresponding three-dimensional images. Using the in-person assessment as the criterion standard, we assessed concordance of the remote with in-person assessments. Measurement variation of area was 3.3% for intraoperator and 11.9% for interoperator; difference in clinician opinion about wound boundary location was significant. Overall agreement for remote vs. in-person assessments was good, but was lowest on the subjective clinical assessments, e.g., value of debridement to improve healing. Limitations of imaging included inability to show certain characteristics, e.g., moistness or exudation. Clinicians gave positive feedback on visual fidelity. This pilot study showed that a clinician viewing only the three-dimensional images could accurately measure and assess a diabetic foot wound remotely.

Applying 21st Century Imaging Technology to Wound Healing: An Avant-Gardist Approach

“…Several credible publications exist on this system's measurement accuracy in well-known journals, 24,25 and a preliminary investigation into the accuracy of remote assessment supports the potential for the system to be used for telemedicine. 25 In this article, remote assessment is the validation of clinically relevant observations made from a remote view of 3D wound images. At least one published paper examines clinician and patient feedback on the system, in the context of healing wounded soldiers.…”

Risk Factors of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

“…Because providers in some communities may not have ready access to specialists, they may consider consultation via electronic or telephonic arrangements (sometimes referred to as telemedicine) [71,72]. Although using high-resolution optical equipment may be optimal [73], even standard or video telephones have allowed expert consultation from a distance [74].…”

Effectiveness of Telemedicine for Distant Wound Care Advice towards Patient Outcomes: Systematic Review and Meta-Analysis

“…Hofmann-Wellenhof, et al [53] Outcome: Comparing accuracy of assessment 46 Ratliff, et al [54] Outcome: Evaluate cost saving and quality of care 47 Halstead, et al [55] Outcomes: Comparing accuracy between tele and in-person assessment 48 Saffle, et al [56] Outcome: Improve resource utilization 49 Clegg, et al [57] Outcome: Cost saving 50 Rasmussen, et al [58] Outcome: Comparing accuracy between tele and in-person assessment 51 Braun, et al [59] Outcome: Feasibility 52…”

“…Van Dillen, et al [47] Outcome: Comparing accuracy of wound image 39 Chen, et al [48] Outcome: Comparing accuracy of assessment 40 Dobke, et al [15] Outcome: Satisfaction and decisional conflict scale score 41 Houghton, et al [49] Outcome: Comparing accuracy of assessment 42 Bowling, et al [50] Outcome: Comparing accuracy of assessment 43 Gardner, et al [51] Outcome: Comparing accuracy of assessment 44 Debray, et al [52] Outcome: Comparing accuracy of assessment 45…”