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Background: Granulation tissue color is recognized to be associated with patient’s nutritional status in pressure ulcer management. However, these relationships remain unclear partly due to lack of quantitative indicators of granulation tissue color.
Purposes: The purposes were to develop the quantitative indicator of granulation tissue color by the digital image analysis and evaluated its reliability and validity. Also, we preliminarily investigated the relationships between the granulation tissue color and nutritional indicators.
Methods: Patients with full-thickness pressure ulcers were included. Pressure ulcers covered with necrotic tissues were excluded. Wound photographs were taken with a color standard. Using the image analysis software, photographic brightness was calibrated and average log(R/G), known as the Erythema index (EI), was calculated from granulation tissue site selected freehand. Also, we calculated the ratio of EI of granulation tissue to color standard as the granulation color index (GCI). To evaluate concurrent validity, we measured a* of granulation tissue as a parameter of redness at the bedside using a tristimulus colorimeter. Nutritional status was evaluated by anthropometric, biochemical/blood and dietary indicators. The protocol was approved by the ethical committee.
Results: Thirty two patients had 38 pressure ulcers. The image analysis of GCI had high repeatability when analyzed twice (ICC=0.99). The EI was not significantly associated with a*, indicating EI was not sufficient indicator in clinical settings. Conversely, the GCI was positively associated with a* (r=0.39, p=0.035). The GCI was tended to be positively correlated with the hemoglobin level (r=0.29, p=0.098) and the amount of dietary protein intake (r=0.34, p=0.070).
Conclusion: Image analysis of photograph is an easy and noninvasive method. The GCI can be a quantitative tool to evaluate the granulation tissue color of pressure ulcers in clinical settings. It is suggested that the granulation tissue color may be associated with nutritional status.
Purposes: The purposes were to develop the quantitative indicator of granulation tissue color by the digital image analysis and evaluated its reliability and validity. Also, we preliminarily investigated the relationships between the granulation tissue color and nutritional indicators.
Methods: Patients with full-thickness pressure ulcers were included. Pressure ulcers covered with necrotic tissues were excluded. Wound photographs were taken with a color standard. Using the image analysis software, photographic brightness was calibrated and average log(R/G), known as the Erythema index (EI), was calculated from granulation tissue site selected freehand. Also, we calculated the ratio of EI of granulation tissue to color standard as the granulation color index (GCI). To evaluate concurrent validity, we measured a* of granulation tissue as a parameter of redness at the bedside using a tristimulus colorimeter. Nutritional status was evaluated by anthropometric, biochemical/blood and dietary indicators. The protocol was approved by the ethical committee.
Results: Thirty two patients had 38 pressure ulcers. The image analysis of GCI had high repeatability when analyzed twice (ICC=0.99). The EI was not significantly associated with a*, indicating EI was not sufficient indicator in clinical settings. Conversely, the GCI was positively associated with a* (r=0.39, p=0.035). The GCI was tended to be positively correlated with the hemoglobin level (r=0.29, p=0.098) and the amount of dietary protein intake (r=0.34, p=0.070).
Conclusion: Image analysis of photograph is an easy and noninvasive method. The GCI can be a quantitative tool to evaluate the granulation tissue color of pressure ulcers in clinical settings. It is suggested that the granulation tissue color may be associated with nutritional status.
Supported by Japanese Society of Pressure Ulcer