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Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma
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Bruce, J. (Julie), Knight, Ruth, Parsons, Nicholas R., Betteridge, Ria, Verdon, Amy, Brown, Julie, Campolier, Marta, Achten, Juul and Costa, Matthew L. (2021) Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma. Bone and Joint Journal, 103-B (12). pp. 1802-1808. doi:10.1302/0301-620X.103B12.BJJ-2021-0447.R1 ISSN 2049-4394.
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WRAP-Wound-photography-evaluation-surgical-site-infection-healing-lower-limb-trauma-2021.pdf - Accepted Version - Requires a PDF viewer. Download (517Kb) | Preview |
Official URL: https://doi.org/10.1302/0301-620X.103B12.BJJ-2021-...
Abstract
Aims
Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery.
Methods
Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs.
Results
Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)).
Conclusion
Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount.
| Item Type: | Journal Article | |||||||||||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery T Technology > TR Photography |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Leg -- Fractures -- Imaging, Wound healing -- Imaging, Medical photography , Image analysis, Diagnostic imaging | |||||||||||||||
| Journal or Publication Title: | Bone and Joint Journal | |||||||||||||||
| Publisher: | British Editorial Society of Bone and Joint Surgery | |||||||||||||||
| ISSN: | 2049-4394 | |||||||||||||||
| Official Date: | 1 December 2021 | |||||||||||||||
| Dates: |
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| Volume: | 103-B | |||||||||||||||
| Number: | 12 | |||||||||||||||
| Page Range: | pp. 1802-1808 | |||||||||||||||
| DOI: | 10.1302/0301-620X.103B12.BJJ-2021-0447.R1 | |||||||||||||||
| Status: | Peer Reviewed | |||||||||||||||
| Publication Status: | Published | |||||||||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||||||||
| Date of first compliant deposit: | 13 August 2021 | |||||||||||||||
| Date of first compliant Open Access: | 1 December 2022 | |||||||||||||||
| Funder: | This work was supported by the UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme: project numbers 10/57/20 and 14/199/14 for UK WOLLF and UK WHIST trials respectively. | |||||||||||||||
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