Validation of three‐dimensional wound measurements using a novel 3D‐WAM camera

Abstract

To monitor wound healing, it is essential to obtain accurate and reliable wound measurements. Various methods have been used to measure wound size including three-dimensional (3D) measurement devices enabling wound assessment from a volume perspective. However, the currently available methods are inaccurate, costly, or complicated to use. As a consequence, we have developed a 3D-wound assessment monitor (WAM) camera, which is able to measure wound size in three-dimension and to assess wound characteristics. The aim of the study was to assess the intrarater and interrater reliability of the 3D wound measurements using the 3D camera and to compare these with traditional measurement methods. Four raters measured 48 wounds using the 3D camera, digital imaging method (2D area), and gel injection into the wound cavity (volume). The data were analyzed using linear mixed effect model. Intraclass and interclass correlation coefficient (ICC) and Bland-Altman plots were used to assess intrarater and interrater reliability for the 3D camera and agreement between the methods. The Bland-Altman plots for intrarater reliability showed minor differences between the measurements, especially the 3D area and perimeter measurements. Moreover, ICCs were very high for both the intrarater and interrater reliability for the 2D area, 3D area, and perimeter measurements (ICCs > 0.99), although slightly lower for the volume measurements (ICC = 0.946-0.950). Finally, a high agreement was found between the 3D camera and the traditional methods (2D area and volume) assessed by narrow 95% prediction intervals and high ICCs above 0.97. In conclusion, the 3D-WAM camera is an accurate and reliable method, which is useful for several types of wounds. However, the volume measurements were primarily useful in large, deep wounds. Moreover, the 3D images are based on digital technology and therefore carry the possibility for use in remote settings.

Instruments of Choice for Assessment and Monitoring Diabetic Foot: A Systematic Review

“…Plain radiography, positron emission tomography (PET), MRI and leukocyte counting were other OCOMs used for the diagnosis of osteomyelitis. The OCOMs with the highest PPV (96%) and NPV (94%) in this subgroup were MRI and PET, respectively, but they require more time and resources than the probe-to-bone test [33,62]. LR+ and LR− have only been calculated for the probe-to-bone test, which gives more support for its use.…”

“…For assessment of ulcer-related variables, the probe-to-bone test for the diagnosis of osteomyelitis seems to be the most valid in clinical practice, notwithstanding its low economic and time costs [38]. The 3DWAM was a valid and reliable OCOM [33], potentially applicable for follow-up of ulcer progress according to its dimensions and healing times.…”

“…This seems essential in those OCOMs where the intervention and interpretation of an examiner are needed for measurement, as with the Neuropad or 10 g mono filament. The latter requires the intervention of a patient and examiner, and with its low inter-rater reliability in children with type 1 diabetes [33] it would be advisable to use other valid OCOMs for this specific population. Hence, the inter-and intra-rater reliability of the 10 g monofilament should be studied in all other target populations.…”

Monitoring Wound Healing of Diabetic Foot Ulcers Using Two-Dimensional and Three-Dimensional Wound Measurement Techniques: A Prospective Cohort Study

“…5 When monitoring wound healing, it is essential to use an accurate wound measurement method, which is able to detect small changes in the wound size, and thereby inform and guide treatment strategies. 6 Accurate wound measurement constitutes a practical problem. 5 Clinical practice has so far relied almost exclusively on two-dimensional (2D) wound measurement techniques, although these are not able to evaluate wound depth, thereby potentially missing an important aspect of wound healing.…”

“…[9][10][11][12] The 3D devices are able to evaluate wound healing from a volume perspective but not commonly used in clinical practice due to several practical limitations, including inaccuracy, high costs, time consumption, and complexity in handling. 5,6 Few of these systems have become commercially available, including the Eykona Ò (Fuel 3D, Los Angeles), Silhouette Ò camera (Aranz, Christchurch, New Zealand), InSight Ò (eKare, Inc., Fairfax, VA), and LifeViz Ò 3D system (Quantificare S.A., Valbonne, France). 13 A recent study compared two of these cameras, the Eykona and Silhouette camera, with digital planimetric method (area) and water displacement (volume) using artificial wound models.…”