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  1. Lucas, Cees PhD, RPt
  2. Classen, Jody RPt
  3. Harrison, Deannine RPt
  4. De Haan, Rob J. PhD, RN


BACKGROUND AND PURPOSE: An essential element in pressure ulcer management is the assessment of wound healing through measurement. The purpose of this study was to investigate the intraobserver and interobserver reliability of measuring pressure ulcers using instant full-scale photography combined with transparency tracings.


SUBJECTS: 26 patients in 3 long-term-care facilities.


METHODS: Duplicate photographs of 30 wounds from 26 subjects were obtained once a week over a period of 2 weeks, resulting in 120 photographs. Duplicate tracings of the photographs were subsequently assessed by 2 independent observers, resulting in 480 observations. The Intraclass Correlation Coefficient (ICC) was used as an indicator of chance-corrected agreement to estimate the relative reliability for the interobserver and intraobserver data. An Altman-Bland plot was also constructed to measure the relationship between interobserver differences and wound surface area.


RESULTS: Analysis of the data showed that all measurement comparisons were highly reliable (ICCs = 0.99). No statistical differences between observed surface areas could be demonstrated.


CONCLUSIONS: The combined wound measurement method described in this study represents a simple, practical, and inexpensive technique to accurately monitor and evaluate pressure ulcer healing. An instant full-scale photographic technique combined with transparency tracings of a wound should be considered for wound measurement, rather than each technique used independently. The results of this study indicate that measurements obtained with this combined method are highly reliable within and between observers.