title: Predictive validity of granulation tissue color measured by digital image analysis for deep pressure ulcer healing: a multicenter prospective cohort study.
abstract: This multicenter prospective cohort study examined the predictive validity of granulation tissue color evaluated by digital image analysis for deep pressure ulcer healing. Ninety-one patients with deep pressure ulcers were followed for 3 weeks. From a wound photograph taken at baseline, an image representing the granulation red index (GRI) was processed in which a redder color represented higher values. We calculated the average GRI over granulation tissue and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) and wound surface (%wound red index 80). In the receiver operating characteristics curve analysis, most GRI parameters had adequate discriminative values for both improvement of the DESIGN-R total score and wound closure. Ulcers were categorized by the obtained cutoff points of the average GRI (≤80, >80), %GRI80 (≤55, >55-80, >80%), and %wound red index 80 (≤25, >25-50, >50%). In the linear mixed model, higher classes for all GRI parameters showed significantly greater relative improvement in overall wound severity during the 3 weeks after adjustment for patient characteristics and wound locations. Assessment of granulation tissue color by digital image analysis will be useful as an objective monitoring tool for granulation tissue quality or surrogate outcomes of pressure ulcer healing.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. iizaka-tky@umin.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Iizaka
authors.forename: Toshiko
authors.initials: T
authors.lastname: Kaitani
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.forename: Ayumi
authors.initials: A
authors.lastname: Naito
authors.forename: Hiroe
authors.initials: H
authors.lastname: Koyanagi
authors.forename: Chizuko
authors.initials: C
authors.lastname: Konya
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003116:Color; D018849:Controlled Clinical Trials as Topic; D005122:Exudates and Transudates / Q000378:metabolism; D005260:Female; D006097:Granulation Tissue / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods*; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000473:pathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012880:Skin Pigmentation; D014945:Wound Healing