Digital images in the diagnosis of wound healing problems

The use of digital wound images could allow remote consultation among patie nts, physicians, or other care givers located at quite distant sites by mea ns of the Internet. To evaluate the efficacy and validity of digital images for the evaluation of wounds, the ability and reliability of surgeons to d iagnose and make treatment suggestions using digital images of several type s of wounds were compared. Twenty-four wound images on 35-mm slides were selected for use in this stud y. Each slide image was digitized at 24 bit color with a resolution of 640 pixels horizontal by 425 pixels vertical and stored as a JPEG file. These i mages were then presented as a slide show on a video monitor, with resoluti on set at 640 X 480. Six physicians examined the images, first in digital f ormat and later in the original slide form. Each observer assessed each wou nd and possible treatment options by filling out a questionnaire using a se ries of yes/no questions. For all observers, there was an 87 percent agreement between digital and sl ide images (p = 0.004). The agreement between the digital and slide images was measured for each individual observer using a kappa coefficient. The ag reement level corresponded to the experience of the observer, with the kapp a values ranging from greater than 0.8 (almost perfect agreement) for the a ttending plastic surgeon to just greater than 0.5 (moderate agreement) for the intern. With this study, the feasibility of distance wound consultation using digit al images of a quality consistent with consumer-grade digital photography w as demonstrated.