Improving Accuracy of Wound Measurement in Clinical Practice

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Author(s): 
Madeleine Flanagan, MA, BSc(Hons), Dip(N), Cert Ed (HE), RGN

M easurement of wounds is an important component of the wound assessment process and has the potential to provide baseline measurements, monitor healing rates, and differentiate between wounds that are static, deteriorating, or improving. However, measurement techniques currently available to clinicians are inaccurate and unreliable, so many clinicians consider wound measurement to be an optional aspect of wound assessment. Apart from serving as an outcome measure of clinical trials or within specialist centers, wound dimension is not normally plotted over time due to lack of time and resources.

A variety of different wound measurement techniques are currently available and range from simple to sophisticated.1 Selecting an appropriate method is dependent on availability of resources, wound type, and location. This review aims to determine means of improving the accuracy of non-invasive measurement techniques so that changes in wound dimension over time can be effectively monitored in clinical practice.

Literature Review

To critically evaluate the efficacy of current wound measurement techniques, electronic databases, including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Embase, Best Evidence, and the Cochrane Database of Systematic Reviews, were searched from January 1965 to February 2003. Statistical pooling of results from trials was considered inappropriate due to inconsistencies between studies in relation to key variables (eg, sample characteristics and outcome measures). Studies appraising biochemical markers and other physical parameters (eg, blood flow, temperature, pH) were beyond the scope of this review because they are not currently widely available. Other criteria for exclusion of papers included: non-English papers, duplication within other sources, or references to unpublished work.

Current Wound Measurement Practice - Approximation of Wound Surface Area

Current measurement of wound dimensions has many limitations. Simple approximations of surface area often are made in clinical practice for superficial, shallow wounds by multiplying the maximum perpendicular length and width measurements (diameter product measurement) (see Table 1). This technique has been shown to be imprecise, especially for large wounds, irregular shaped wounds, or cavities, because area is generally overestimated2 but is used to provide a baseline for evaluation of healing. Reliability could be improved if the points from which measurements are taken are carefully documented (see Figure 1). Many different procedures have been recommended to improve accuracy of diameter product measurements, including use of perpendicular measurements and clockwise techniques,3 but precision has not been effectively demonstrated in clinical practice for either.4

Alternatively, area can be estimated by tracing the wound outline onto a clear film using a fiber-tipped pen (see Figure 2) or by using photographic images. The circumference can then be transferred onto graph paper so that the surface area of the wound can be crudely estimated by counting each full square that falls within the perimeter of the wound tracing; half squares can be added up in the same way. Counting squares on graph paper is subjective, especially when adding up incomplete squares. This technique depends heavily on the clinical judgment of the user to determine the exact extent of the wound. Tracings made in this way do not record the three-dimensional aspect of the wound and provide no information relating to depth and volume.5

References: 

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