Does 3D Technology Have Clinical Application in Nursing Assessment of Wounds in Adult Care Settings?

Friday, 28 July 2017

Martina Mendoza, MSN, BSN1
Joyce Elaine Emery, MSN, BSN1
JoAnn D. Long, PhD, RN, NEA-BC2
(1)Nursing Administration, Covenant Health System, Lubbock, TX, USA
(2)Department of Nursing, Lubbock Christian University, Lubbock, TX, USA

Purpose:  The purpose of this project is to describe the state of nursing science using 3D imaging as an adjunct for pressure injury documentation and subsequent clinical care.

Background: Pressure injuries present a major health care challenge worldwide


 Pressure injuries are considered a “never event” by the Center for Medicare and Medicaid Services (Soban et al, 2016). Accurate measurement of wound size is vital in monitoring the wound healing process and is a central concern in the practical management of wounds and the development of new treatment preferences. Additionally, the United States Centers for Medicare and Medicaid Services and insurance companies require accurate wound surface dimension data (Martin et al, 2011). Data is used to determine reimbursement for specialized treatment such as negative pressure therapy, specialty surfaces, and bioengineered skin substitutes. Wound measurement methods need to be accurate, reliable and feasible if they are to be useful in evaluating the wound healing process. A factor affecting the accuracy of wound measurement is definition of the wound boundary, which is often difficult to identify (Jorgensen et al, 2015). The National Pressure Ulcer Advisory Panel recommends at least a 1.5-3 mega-pixel digital camera for photographing wounds as an adjunct to support written wound documentation (Bryant et al, 2015). Problems with current digital imaging, resulting in underestimation of the wound area, include: poor lighting, location and size of the wound, differences in camera angle, user error, inaccurate recording of wound dimensions, documentation errors, and ineffective internet connectivity to upload into EMR (Jorgensen et al, 2015). Digital imaging is time consuming from the instant the image of the wound is captured by the camera until the wound area is estimated by the software. Recent advances in 3D imaging may help to overcome obstacles related to precise wound measurement; however, the efficacy of this technology as a tool in nursing assessment of wounds in not fully known

Methods:   An integrative literature review was conducted using PubMed; Google Scholar; CINAHL; Cochrane Database of Systematic Reviews. Key Words included: Stereophotogrammetry (SPG), 3D scanning; Instruments to Measure Pressure Ulcers; stereophotogrammetry technique and wounds; instruments to measure pressure ulcers; wound documentation; stereophotogrammetry and 3D photographs, legal costs of pressure ulcers, use of 3D scanners in wound assessment, Pressure ulcer Assessment; pressure ulcer documentation, , measuring wounds, wound assessment, 3 D photography, digital planimetry. All peer-reviewed articles published to date were included. The following were included: adult care settings, wounds and pressure injures. Children and animals were excluded. Eleven articles were initially located and five were included in the final sample. Data were extracted and synthesized.

 Results: One level one meta-synthesis (Jorgensen et al, 2015); One level three comparative study (O’Meara, S.M. et al, 2012); One level four qualitative study were included (Hammond, C.P., & Nixon, M.A. 2011).In the past decade various 3D imaging from a volume perspective have appeared on the market, however none of the reviewed technologies have yet had a major impact due to low accuracy, high cost and difficulty in handling the system setup. Only a few of the studies provide data on wound selection criteria, thus reducing the generalizability of the results (Jorgensen et al, 2015). The SilhouetteMobile, Aranz Medical, included five wounds and was found to have low intra-and inter-rater variation and with approximately two minutes were required to capture photographic documentation (Hammond, C.P., & Nixon, M.A. 2011). Twelve studies were included, however no definitive conclusion could be reached in regards to the diameter or depth of the wounds (O’Meara, S.M., et al 2012).

Conclusion: The use of digital planimetry or digital imaging may be a solution for wound measurement if a high accuracy is required, however, the methods can also be time consuming for everyday clinical practice. Absence of a Gold Standard method for wound area and volume measurement against which other methods can be tested is a current concern. Currently there is little evidence to recommend clinical guidelines. Technological advances in digital imaging may help to advance the science underpinning wound care and more research is required to find ways to better validate wound volume measurement.