Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice

Abstract

Background Photographing injuries in the acute setting allows for improved documentation as well as assessment by clinicians and others who have not personally examined a patient. This tool is important, particularly for telemedicine, tracking of wound healing, the evaluation of potential abuse, and injury research. Despite this, protocols to ensure standardization of photography in clinical practice, forensics, or research have not been published. In preparation for a study of injury patterns in elder abuse and geriatric falls, our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied. Methods We conducted a literature review for techniques and standards in medical, forensic, and legal photography. We developed a novel protocol describing types of photographs and body positioning for eight body regions, including instructional diagrams. We revised it iteratively in consultation with experts in medical photography; forensics; and elder, child, and domestic abuse. The resulting protocol requires a minimum of four photos of each injury at multiple distances with and without a ruler/color guide. To evaluate the protocol’s efficacy, multiple research assistants without previous photography experience photographed injuries from a convenience sample of elderly patients presenting to a single large, urban, academic emergency department. A selection of these patients’ images were then evaluated in a blinded fashion by four nontreating emergency medicine physicians and the inter-rater reliability between these physicians was calculated. Results Among the 131 injuries, from 53 patients, photographed by 18 photographers using this protocol, photographs of 25 injuries (10 bruises, seven lacerations, and eight abrasions) were used to assess characterization of the injury. Physicians’ characterizations of the injuries were reliable for the size of the injury (κ = 0.91, 95% confidence interval [CI] = 0.77 to 1.00), side of the body (κ = 0.97, 95% CI = 0.88 to 1.00), precise location of the injury (κ = 0.74, 95% CI = 0.63 = 0.81), and type of abrasion (κ = 0.76, 95% CI = 0.45 to 1.00). The exact shape of the injury (κ = 0.44, 95% CI = 0.17 to 0.51), and the primary color of bruises (κ = 0.37, 95% CI = 0.25 to 0.48) were not as reliably characterized. Conclusions Standardizing the documentation of injuries with photographs for clinical and research assessment can be conducted by nonprofessional photographers. A photography protocol will ensure that this important mechanism for documentation is optimized.

Developing the Geriatric Injury Documentation Tool (Geri-IDT) to Improve Documentation of Physical Findings in Injured Older Adults

“…photography, particularly when using personal mobile devices such as smart phones and tablets, including privacy concerns, 32,33 safe storage, 32,34,35 and photo quality (e.g., methods for taking photos, location clearly depicted, size/ scale clearly portrayed). 9,35 Although research in this area is currently bourgeoning, much of this work has focused on the use of personal mobile devices for telemedicine (triage, consultation, and diagnosis) [36][37][38] and remote wound monitoring. 39,40 Less work is focused on using photography to increase accuracy and detail of documentation of physical findings, though this has been recognized in the field of dermatology.…”

“…[5][6][7][8] Reasons likely include clinicians' lack of training, time limitations, and the low immediate clinical significance of some injuries and physical findings. 9 Additionally, potentially valuable ancillary strategies to enhance documentation of injuries such as photography are currently underutilized, 9,10 due to technical challenges and privacy concerns.…”

Describing visible acute injuries: development of a comprehensive taxonomy for research and practice

“…We also manually reviewed existing forensics and injury epidemiology textbooks. We used a similar literature review strategy in developing a novel protocol for photographing injuries in the acute care setting 59. Although we were unable to identify any existing comprehensive classification systems in our review, we did find literature that informed the development of our taxonomy.…”

“…Geriatric fall victims were enrolled prospectively on presentation to a large, urban, academic medical centre emergency department. Photographs of all injuries were taken using a standardised protocol,59 and medical records were reviewed. Private screening was performed at intake including elements of the previously validated Elder Abuse Suspicion Index60 to ensure that fall victims were not actually elder abuse victims.…”

Workflow Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper

“…While historically, the radiology and cardiology services have done a good job creating automated workflows for image acquisition and information systems for image distribution, these practices have not been adopted by other services in the hospital. Today, the majority of services use some form of imaging in their practice [ 1 , 2 , 4 , 5 , 7 – 13 , 16 , 18 – 20 ].…”