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Dear Readers: An old adage says, “You can’t manage what you don’t measure.” Measuring wound features allows you to track progress, providing you and your patients with feedback about how well the current protocols of patient and wound care are working. This month’s Evidence Corner covers two recent articles on wound measurement. The first, for CME credit, reviews techniques for measurement of several wound or patient characteristics and illustrates how appropriate measurement can guide care. The second article focuses on measuring wound size and explores the reliability and concurrent validity of wound size measurements made by hand or assisted by a computer. Both illustrate strengths and efficiencies that wound measurement adds to clinical practice. In addition, the readers should be alerted to the section, Skin Measurement Techniques, which will be featured in the upcoming March issue of WOUNDS.
Laura Bolton, PhD
An Overview of Wound Measurement Tools
Reference: Goldman RJ, Salcido R. More than one way to measure a wound: An overview of tools and techniques. Adv Skin Wound Care 2002;15:236–45.
Rationale: Clinicians can improve their clinical practice and the quality of patient care by enhancing understanding of the tools and techniques available for wound measurement.
Objective: Advantages and disadvantages are described for various techniques of measuring wound dimensions, visual and photographic assessment methods, and vascular and pressure assessment methods.
Methods: The authors review the literature on measuring wound length, width, depth, area, volume, visual assessments, such as wound bed color, techniques for managing digital images, and photogrammetry, in which a computer evaluates wound images. Recognizing that wounds need good circulation to heal, they also describe the ankle-brachial index (ABI) as a test of arterial insufficiency, segmental volume recording, also known as pulse volume recording, and transcutaneous oximetry to clarify the nature and site of arterial insufficiency as well as point-sensors and pressure mapping to identify pressure problems.
Results: In addition to benefits and drawbacks of each measurement technique, the noninvasive circulatory results illustrate in patient scenarios how measurement assists in wound care decision making. For example, ABI is reportedly useful as a bedside procedure to exclude arterial insufficiency and determine if therapeutic compression can be safely applied. Features, benefits, and costs of wound measurement and pressure mapping tools are also compared.
Conclusions: In choosing wound measurement techniques to meet their wound care goals, clinicians and researchers balance practical issues, such as time and resources involved, against scientific issues, such as reliability and validity of the results or the constraints of practice patterns, staff knowledge and skills, certification guidelines, and cost.
Clinical perspective: Measuring wound and patient risk factors can enhance clinical wound care by giving an evidence-based edge to clinical experience, which allows clinicians to track patient and wound progress and incorporate legally defensible, objective criteria into clinical decision making. The feedback from tracking progress can motivate patients and staff and inform clinicians when protocols of care are or are not working so all can move forward to improve outcomes.
Computer-Assisted Compared to Manual Wound Size Measurement
Reference: Thawer HA, Houghton PE, Woodbury G, Keast D, Campbell K. A comparison of computer-assisted and manual wound size measurement. Ost/Wound Manag 2002;48(10):46–53.
Rationale: Accurately, precisely measuring wound size documents wound progress and effectiveness of interventions.
1. van Rijswijk L, Polansky M. Predictors of time to healing deep pressure ulcers. Wounds 1994;6:159–65.
2. van Rijswijk L, Multi-Center Leg Ulcer Study Group. Full-thickness leg ulcers: Patient demographics and predictors of healing. J Fam Prac 1993;36(6):625–32.