Point of care ultrasound imaging as a wound assessment tool in diabetic foot ulcers

NewsBot · Aug 19, 2020

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Point of care ultrasound imaging as a wound assessment tool in diabetic foot ulcers: a case series
Frances R Henshaw et al
J Wound Care. 2020 Aug 1;29(Sup8):S28-S34

Foot ulceration is a common and devastating complication of diabetes. Traditionally, diabetic foot ulcers (DFU) are managed by multidisciplinary teams in tertiary hospital settings. Wound management decisions are based largely on visual observations at the point of care, using rudimentary evaluation of superficial tissues, such as wound tracings and photography combined with expert knowledge of the treating practitioners. Imaging based methods of assessment, such as X-ray, magnetic resonance imaging, scintigraphy or computed tomography are able to more comprehensively categorise wounds and to determine whether re-epithelialised wounds are in fact healed. Ultrasound has been advocated by the World Health Organization for the monitoring of chronic diseases and for screening because it is considered low risk, comfortable for patients and low cost. It can be performed in real time at the point of care and using B-mode, Doppler and elastography has the potential to provide clinically meaningful information for monitoring the status of hard-to-heal wounds, but to date this imaging technique has not been exploited in this field. This case series highlights the utility of diagnostic musculoskeletal ultrasound as an adjunct to traditional wound assessment that can provide diagnostically meaningful information to assist in clinical decision making. Future research will be needed to determine if routine incorporation of ultrasound in wound assessment improves patient outcomes.
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NewsBot · Sep 7, 2020

Wound assessment, imaging and monitoring systems in diabetic foot ulcers: A systematic review
Kai Siang Chan Zhiwen Joseph Lo
23 August 2020

Patients with diabetes mellitus have a lifetime risk of 15% to 25% of developing diabetic foot ulcers (DFUs). DFU is associated with significant morbidity and mortality. Wound imaging systems are useful adjuncts in monitoring of wound progress. Our study aims to review existing literature on the available wound assessment and monitoring systems for DFU. This is a systematic review of articles from PubMed and Embase (1974 – March 2020). All studies related to wound assessment or monitoring systems in DFUs were included. Articles on other types of wounds, review articles, and non‐English texts were excluded. Outcomes include clinical use, wound measurement statistics, hospital system integration, and other advantages and challenges. The search identified 531 articles. Seventeen full‐text studies were eligible for the final analysis. Five modalities were identified: (a) computer applications or hand‐held devices (n = 5), (b) mobile applications (n = 2), (c) optical imaging (n = 2), (d) spectroscopy or hyperspectral imaging (n = 4), and (e) artificial intelligence (n = 4). Most studies (n = 16) reported on wound assessment or monitoring. Only one study reported on data capturing. Two studies on the use of computer applications reported low inter‐observer variability in wound measurement (inter‐rater reliability >0.99, and inter‐observer variability 15.9% respectively). Hand‐held commercial devices demonstrated high accuracy (relative error of 2.1%‐6.8%). Use of spectroscopy or hyperspectral imaging in prediction of wound healing has a sensitivity and specificity of 80% to 90% and 74%to 86%, respectively. Majority of the commercially available wound assessment systems have not been reviewed in the literature on measurement accuracy. In conclusion, most imaging systems are superior to traditional wound assessment. Wound imaging systems should be used as adjuncts in DFU monitoring.
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NewsBot · Jan 2, 2021

Wound assessment, imaging and monitoring systems in diabetic foot ulcers: A systematic review
Zhiwen Joseph Lo
23 August 2020

Patients with diabetes mellitus have a lifetime risk of 15% to 25% of developing diabetic foot ulcers (DFUs). DFU is associated with significant morbidity and mortality. Wound imaging systems are useful adjuncts in monitoring of wound progress. Our study aims to review existing literature on the available wound assessment and monitoring systems for DFU. This is a systematic review of articles from PubMed and Embase (1974 – March 2020). All studies related to wound assessment or monitoring systems in DFUs were included. Articles on other types of wounds, review articles, and non‐English texts were excluded. Outcomes include clinical use, wound measurement statistics, hospital system integration, and other advantages and challenges. The search identified 531 articles. Seventeen full‐text studies were eligible for the final analysis. Five modalities were identified: (a) computer applications or hand‐held devices (n = 5), (b) mobile applications (n = 2), (c) optical imaging (n = 2), (d) spectroscopy or hyperspectral imaging (n = 4), and (e) artificial intelligence (n = 4). Most studies (n = 16) reported on wound assessment or monitoring. Only one study reported on data capturing. Two studies on the use of computer applications reported low inter‐observer variability in wound measurement (inter‐rater reliability >0.99, and inter‐observer variability 15.9% respectively). Hand‐held commercial devices demonstrated high accuracy (relative error of 2.1%‐6.8%). Use of spectroscopy or hyperspectral imaging in prediction of wound healing has a sensitivity and specificity of 80% to 90% and 74%to 86%, respectively. Majority of the commercially available wound assessment systems have not been reviewed in the literature on measurement accuracy. In conclusion, most imaging systems are superior to traditional wound assessment. Wound imaging systems should be used as adjuncts in DFU monitoring
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NewsBot · Jan 31, 2022

The evaluation of podiatrists, with knowledge and training in diagnostic musculoskeletal ultrasound, to describe sonographic images of diabetic foot wounds in the United Kingdom and Australia
Charlotte Dando, Georgia Lane, Catherine Bowen & Frances Henshaw
Journal of Foot and Ankle Research volume 15, Article number: 5 (2022)

Aims
Currently, wound management decisions are based largely on visual observations such as photographs, descriptors or measurements which can lack detail and do not always capture the sub-wound area. A previous case series suggests that there is benefit in using ultrasound imaging (USI) to evaluate diabetic foot ulcers (DFU) at point-of-care, however no guidance exists to inform its use. This scoping exercise explores the capacity of podiatrists with experience in interpreting musculoskeletal structures using USI to interpret sonographic images of DFU.

Methods
Following a short briefing session, podiatrists with previous musculoskeletal (MSK) USI training were asked to review and report on previously recorded static sonographic images (n = 8) of active DFU. Content analysis was utilised to identify recurring keywords within the podiatrists’ reports which were coded and assigned to categories to gain context to the data.

Results
Seven podiatrists participated in the study. Four categories were constructed for the purposes of analysis:

1)
Frequency of reporting, 2) Language used in reporting, 3) Observations, 4) Clinical impression

Frequently, the reported findings between podiatrists were found to be similar, especially those related to bone morphology. However greater variability was seen in the reporting of wound specific soft-tissue observations.

Conclusion
This scoping exercise has shown that podiatrists can translate their existing USI skills to make rudimentary reports on clinical findings in DFU. All participants were consistently able to identify and describe characteristics associated with DFU from a single b mode static wound ultrasound image. Findings from this investigation can be used as a foundation for further work to establish accuracy and reliability to validate DFU sonography. In conjunction the development of protocols and training materials will enable the adoption of USI to assess DFU in clinical practice. This will in turn, contribute to improved patient care and establish a new paradigm for wound surveillance which is translatable to other wound types.
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