Sven, Van Poucke, MD

Introduction to

the...

Chronic wounds:

Problem?

Chronic wounds:

Problem?Pressure ulcers

(also known as pressure sores, bed sores, and decubitus ulcers)

Incidence / PrevalencePrevalence rates range from 4.7–32.1% for hospital populations, 4.4–33.0% for community-care populations, and 4.6–20.7% for nursing-home populations.

Kaltenhaler E, Whitfield MD, Walters SJ, et al. UK, USA, and Canada: how do their pressure ulcer prevalence and incidence data compare? J Wound Care 2001;10:530–535. [PubMed]

Chronic wounds:

Problem?Diabetic Ulcers

Incidence / Prevalence

Studies conducted in Australia, Finland, the UK, and the USA, have reported the annual incidence of foot ulcers among people with diabetes as 2.5–10.7%, and the annual incidence of amputation for any reason as 0.25–1.8%.

BMJ Clinical Evidence

Chronic wounds:

The overall incidence of venous stasis syndrome and venous ulcer were 76.1 and 18.0 per 100,000 person-years, respectively. The incidence of both was higher in women than in men (83.7 vs 67.4 per 100,000 person-years for venous stasis syndrome; 20.4 vs 14.6 per 100,000 for venous ulcer) and increased with age for both sexes.

Problem?Ulcus Cruris

Venous UlcerLeg Ulcer

Incidence / Prevalence

Chronic wounds:

CostsChronic wounds cost the UK over £1 billion each year

Chronic wounds cost the nation (USA)$20 billion to $25 billion a year

Harding, KG, Morris, HL and Patel, GK. "Healing chronic wounds." BMJ 324: 160-163, 2002

Chronic wounds: the facts

Chronic or nonhealing ulcers:

-defective remodeling of the extracellular matrix, -a failure to reepithelialize, -and prolonged inflammation.

Monitoring of acute and chronic wounds:

by measuring in an objective, precise, and reproducible way

Middle Ages?

Chronic wounds: 1. the prevalence and cost of managing chronic wounds continue to escalate,

2. despite the availability of advanced wound care products, specialists and consultants, and the creation of risk assessment tools and wound healing centers.

3. serious morbidity and financial costs precipitated by these wounds,

4. a serious call is made to health care providers, payers, and policymakers to revisit the way such wounds are managed today.

Chronic wounds: the problem 1.Treatment decisions are based on visual perception.

2.Descriptive analysis of wounds is poorly standardized and rarely reproducible. 3.The assessment and measurement of the temporal changes of wounds using digital images can now be calibrated, reducing the difficulty of obtaining reproducible color content.

The color content of the images becomes independently of any camera settings and illumination features.

4. Growing demand for randomized clinical trials, health technology assessments and increasing economical pressure on health budgets: optimal data sharing with standardization and agreements on universals and instances.

5. Consistent, controlled and universally accepted vocabularies seems essential for documenting, describing and comparing wounds.

6. Ontologies (controlled vocabularies) promise to help address many of the difficulties currently experienced in managing large image databases.

<< >>Documentation Assessment

non-invasive wound assessment by image analysis:

Wound bed preparation - a procedure aimed at assisting clinicians in wound bed assessment and the development of strategies to maximise healing potential - is now recognised as an important aspect of care.

The Red-Yellow-Black-scheme is commonly used for classifying chronic wounds. Simplified direction for selecting appropriate

dressings for open wounds by focusing on the phase of healing

as evidenced by the predominant condition of the wound base

The associated development of the TIME framework (Tissue management; Inflammation and infection control; Moisture balance; Epithelial (edge) advancement) offers clinicians a practical tool for translating wound bed

preparation into practice. Falanga V. Wound bed preparation: science applied to practice. In: European Wound Management Association (EWMA). Position Document. Wound Bed Preparation in Practice. London: MEP Ltd, 2004; available from URL: http://www.ewma.org/.

non-invasive wound assessment by image analysis: wound bed preparation

M Flanagan The Philosophy of Wound Bed Preparation in Clinical Practice 2003Preparing the Wound Bed 2003: Focus on infection and inflammationOstomy Wound management; 49(11):24-51Sibbald RG, Orsted H, Schultz GS, Coutts P and Keast D

non-invasive wound assessment bymage analysis: measurement Wound measurement and assessment is important

for several reasons including:

Tracking patient progress to ensure that healing of a specific wound is progressing with the selected treatment regime

Allowing institution managers to audit patient progress and institution effectiveness

Building a reliable and consistent database for outcomes based studies of wound care

Improving patient compliance

Consistently documenting patient care for reimbursement purposes and for protection of the health care provider against litigation.

16

some efficiencysome efficacy

something is missing

The Club

The Club House

1. a free accessible database and archive system for high-quality multidimensional digital images of wounds, with their supporting metadata.

2. anonimized images and their metadata available electronically for personal study, educational (clinical dicision support systems), commercial, medical and scientific research purposes.

3. tools and interfaces to assist in the submission, discovery, downloading and visualization of such images, and making comparisons between them.

4. links between these images and relevant items including semantics, clinical information, ontologies, etc.

5. facilitate effective data representation and information visualisation through the construction of adaptive interfaces that meet the needs of individual users.

6. To provide tools for assisting in annotation of wound images and the development of ontologies related to these images.

7. To develop theoretical (mathematical, colorimetric,...) models related to the language and terminology used by the wound care community.

Woundontology Consortium Working Groups

1. Wound Image Base Working Group

2. Wound Image Visual Diagnostic Expert Group

3. Wound Image Colour, Pattern, Texture and Shape Group

4. Wound Image Ontology Working Group

Woundontology Consortium Working Groups Wound Image Ontology Working Group:

Involvement of domain (clinical) experts in the knowledge elicitation process as preparation of ontology development.

Woundontology Consortium Working Groups Wound Image Ontology Working Group:

Involvement of domain (clinical) experts in the knowledge elicitation process as preparation of ontology development.

Woundontology Consortium

The Woundontology Consortium is a semi-open, international, virtual community of practice devoted to advancing the field of research in non-invasive wound assessment by image analysis, ontology and semantic interpretation and knowledge extraction .

Web: www.woundontology.comImage Server: www.colibrate.comEmail: info@woundontology.comDiscussion: http://groups.google.com/group/woundontology Discussion Email woundontology@googlegroups.com