Wound debridement: Comparative reliability of three methods for measuring fibrin percentage in chronic wounds

Abstract

The purpose of this study was to examine the intra-and interrater reliability of three methods to measure the percentage of fibrin within a wound, hence reflecting wound debridement. The three methods include visual assessment, a portable wound measurement system (PWMS) Visitrak s , and a computerized planimetry software Canvas s . The main objective was to compare the computerized planimetry with visual analysis. For each wound, a series of two repeated recordings of fibrin percentage based on the same Day 1 photograph at Day 8 and Day 15, respectively, was assessed by four evaluators using the two methods. Additional objectives consisted in the assessment of the inter-rater reliability of computerized planimetry and PWMS to assess fibrin percentage and total surface area. Twenty-four patients were included for a total of 31 wounds. Intraclass correlation coefficient revealed improved reproducibility and repeatability of computerized planimetry. The reproducibility of computerized planimetry was better than PWMS when measuring the percentage of fibrin and total wound area. Because average visual estimations were very close to the computerized planimetry, bedside evaluation of fibrin percentage and wound debridement was considered as reliable, and consequently a valid technique for daily practice. PWMS proved to be less convenient, owing to difficulties in identifying fibrin margins. The higher intra and interrater reliability of computerized planimetry probably reflected the fact that subjective clinical assessment and objective calculation of percentages were mandatory for correct wound evaluation. Therefore, digital image analysis was considered as an accurate method for double-blind and multicentric trials.Chronic wounds are a major problem in developed countries resulting in substantial morbidity and cost to healthcare systems.

The use of wound healing assessment methods in psychological studies: A review and recommendations

“…Visitrak™ has clinical practicality, taking only a second to calculate area (Laplaud et al , 2010), significantly faster than using digital planimetry (Sugama et al , 2007). The system is more accurate than the linear measurement technique, has high intra‐ and inter‐rater reliability and validity, and requires no special training (Haghpanah et al , 2006; Sugama et al , 2007).…”

“…The integration of computerized planimetry software with commonly used digital cameras and personal computers makes this technology relatively affordable, user‐friendly, and clinically practical. Computerized planimetry software programs include PictZar ® Calibrated Digital Measurements (BioVisual Technologies LLC, Elmwood Park, NJ; Wendelken, 2010), and Canvas ® (ACD systems, British Columbia; Laplaud et al , 2010). The wound is imaged with a ruler for calibration purposes.…”

“…The wound perimeter is manually traced on the computer screen using a mouse. Software capabilities include computing wound dimensions, surface area, volume (if wound depth is provided), and colorimetric analyses for monitoring changes in surface area by tissue type (Laplaud et al , 2010; Wild et al , 2008). Software resolution is 0.01 cm 2 (Laplaud et al , 2010).…”

“…Software capabilities include computing wound dimensions, surface area, volume (if wound depth is provided), and colorimetric analyses for monitoring changes in surface area by tissue type (Laplaud et al , 2010; Wild et al , 2008). Software resolution is 0.01 cm 2 (Laplaud et al , 2010). While there is no limit of wound size, larger circumference wounds may not be fully captured with one image, thus requiring multiple images, which can increase measurement error (Palmer et al , 1989).…”

A Study of the Utility and Equivalency of 2 Methods of Wound Measurement

“…After uploading the image to a computer, the wound surface area can be calculated using one of a number of software programs, either by tracing the wound edge using a pointer tool 7,10 or by evaluating color values within the wound perimeter. 11 However, photographic methods, like the ruler approach, present a challenge when wounds wrap around the limb or extend over contours and under skin folds, leading to possible measurement error. 12Y14 Without due diligence, photographic measurements are also prone to parallax error.…”