A Comparison of Computer-Assisted and Manual Wound Size Measurement

  • Wed, 9/3/08 - 10:25am
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Author(s): 
Habiba A. Thawer, BScPT, MSc, PhD; Pamela E. Houghton, BScPT, PhD; M. Gail Woodbury, BScPT, MSc, PhD; David Keast, MSc, MD, CCFP; and Karen Campbell, MScN, RN, NP/CNS

T he ability to accurately and precisely measure the size of a wound is critical in documenting the progress to healing and in assessing the effectiveness of interventions on the healing process in clinical and research settings.1-3 Several techniques are available for documenting wound size, including measuring the dimensions of a wound using a disposable ruler. Ruler-based assessments of wound size have good reliability.4 However, deciding which dimensions to measure if the wound is irregular can be difficult.5 Furthermore, this ruler-based technique tends to overestimate the actual size of the wound, and the reliability of this technique decreases as wound size increases.6

Tracing the wound edges onto a transparency is also a popular method of assessing wound size. The tracings can be placed onto metric grid paper and the number of square millimeters counted to document the surface area of the wound.7 This process is time consuming, especially if the wound is large. The tracing also can be cut out and weighed on a precision scale.8 This method may be faster than the square counting method, but the second transfer and cutting out the shape of the wound reduces the accuracy of the technique.8,9 Tracing the edge of a wound onto a transparency and using an electronic or computerized device such as a planimeter to quantify the surface area of the wound appears to be a popular and practical method for assessing wound surface area and has been utilized and studied extensively.8,10,11 Excellent interrater and intrarater reliability has been reported with this manual technique.7,12 Inexpensive and convenient to use, it requires minimal training and provides readily available results. Potential disadvantages include: difficulty identifying the edge of a wound,8,13 inaccurately tracing wounds in the presence of a skin fold, or, when conforming the transparency over the wound, causing a deformation of wound shape and size.14 The reliability of this manual technique lessens with decreasing wound size.6

Stereophotogrammetry (SPG) refers to computer-assisted measurement of digital and photographic images, including images of wounds. Stereophotogrammetry utilizes two cameras to reconstruct a three-dimensional image from which the surface area and volume of a wound can be determined.14 This three-dimensional technique is time consuming, expensive, and requires specialized training, making it less than ideal for routine clinical use. Three studies have examined the reliability and precision of SPG for measurement of wound dimensions. Bulstrode et al,1 using artificial leg ulcers, found less than 1% difference between the known surface area of the wound and surface area measurements obtained using SPG. Frantz and Johnson15 reported Pearson correlation coefficients ranging from 0.96 to 0.99, indicating excellent interrater reliability for determining surface area, circumference, depth, and volume of pressure ulcers using SPG. These results are similar to those reported by Eriksson et al16 who used SPG to determine the dimensions of venous stasis ulcers.

References: 

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