By Matthew Regulski, DPM
One of the most difficult challenges in wound care today is deciding exactly which treatments to use. Due to the high inaccuracy of wound evaluation techniques, specifically ruler measurements, it is extremely difficult to quantify changes in a wound's progress. In addition to the lack of an accurate and objective quality metric for evaluating wounds, modern electronic health records are simply not built to handle analysis of data. A tremendous amount of manual labor is required to sift through a month's worth of data (or usually much, much more!) and put it into a format that can be easily analyzed. These are issues that I have encountered consistently in my nearly 13 years of practicing podiatry.
However, when I came across a novel advanced wound documentation and imaging system in late 2015, I thought I may have finally found a solution to this problem. The product comes in the form of a mobile application for documenting and photographing wounds and a Web-based portal for longitudinally viewing their progress. My nursing staff and I were able to start using the application on our iPhones. After capturing a standard iPhone image, the software is able to very quickly and accurately measure my patients' wounds using cutting edge imaging algorithms.The software provides me with a fully objective surface area of the wound; by this I mean the actual area enclosed by the perimeter of the wound and not just the standard, inaccurate length-times-width calculation we are used to performing. The software also automatically provides me with a breakdown of the surface tissue composition of wounds using a color scale. A final crucial feature of the software is that I was able to upload my specific treatment formulary to the app, which allowed me to accurately record exactly which treatments I was using each visit. The ability to collect an accurate and objective quality metric combined with the customizations I was able to perform made me optimistic that I would be able to see which of my treatments were performing best for my patients..
Documenting the Velocity of Healing
After I had used the advanced documentation system in each wound visit taking place in my clinic for about a year, amounting to nearly 1300 data points, I worked with individuals developing the software to explore the efficacy of a set of five of my most frequently used treatment protocols. The results of this evaluation were quite fascinating, and I am excited to be presenting these findings in detail at the Symposium on Advanced Wound Care (SAWC) in the Spring. However, in order to illustrate the nature of these findings in this post, I will share a sample of the results as they pertain to one of the products that I frequently use. This product, which is intended to directly target wound biofilm based on the actual bacterial make-up of the biofilm, will be termed generically as biofilm-based wound care (BBWC) for the remainder of this write-up.
The key wound healing metric the advanced documentation system provides is what they call "Healing Velocity" (HV). This refers to the daily rate of change of a wound's surface area over time, which is calculated using the change in automatically measured surface area between visits. It is the system's ability to quantify small changes in wound area that allows it to utilize this metric to generate effective insights. Figure 1 below compares the mean HV for wounds receiving BBWC with those not receiving BBWC.Figure 1: Mean HV comparison for patients receiving BBWC with those not receiving BBWC. A positive y-axis value indicates the wound has decreased in surface area and as such a higher positive value is the clinically desirable outcome. The n-value refers to the number of visits that constitute one of the bars. P-value indicates significance.
As the results illustrate, wounds treated with BBWC tend to have faster healing rates than those that do not receive the treatment. While this result is somewhat meaningful, the software allowed me to delve even deeper. The next thing we examined was whether the time of application of BBWC relative to the start of wound care affected healing rates (see figure 2). The documentation software allowed me to quantify and visualize this result, which would have been too time-consuming to compile with traditional methods.Figure 2: MHV of wounds treated with BBWC compared to those not treated with BBWC based on when the treatment was applied relative to the patient's start of care.
The Impact of Big Data on Clinical Practice
This result is significant and justifies further explanation. The result shows that BBWC is most effective when used later in a patient's care. The result also tells me that if I use BBWC consistently in the 30-60 day interval, my patients' wounds will heal significantly faster (p<0.05) than if I do not. The true beneficiaries of this type of information, of course, are my patients as easy access to highly accurate information allows me to help them heal faster. I am truly excited to see what else I may discover about my patients' wounds as I continue to use advanced wound documentation and large prospective data sets in clinical practice for years to come.
Product: Mobile Wound Care by Tissue Analytics, Inc.
About the Author
Matthew Regulski is a podiatrist based in Toms River, New Jersey. He is the Director of the Wound Institute of Ocean County New Jersey and a partner at the Ocean County Foot and Ankle Associates. He has been performing wound healing and diabetic reconstructive surgery for 13 years. Dr. Regulski is an author on multiple peer-reviewed journal articles, a principal investigator for several large randomized control trials and an internationally-renowned lecturer in his areas of expertise.
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