Gojiro Nakagami, PhD
,
Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, RN, Tokyo, Japan
Shinji Iizaka, BHS, RN
,
Department of Gerontological Nursing, Graduate School of Medicine, University of Tokyo, Graduate Student, Tokyo, Japan
Takafumi Kadono, PhD, MD
,
Department of Dermatology, Gaduate School of Medicine, University of Tokyo, Lecturer, Tokyo, Japan
Noriyuki Aoi, MD
,
Department of Plastic Surgery, Gaduate School of Medicine, University of Tokyo, PhD Student, Tokyo, Japan
Mitsuko Uno, RN
,
Department of Nursing, The University of Tokyo Hospital, Nurse, Tokyo, Japan
Hiroe Koyanagi, MHS, RN, WOCN
,
Department of Nursing, The University of Tokyo Hospital, Nurse, Tokyo, Japan
Yoshie Shigeta, MHS, RN
,
Department of Adult and Gerontological Nursing, School of Nursing, University of Shizuoka, Assistant Professor, Shizuoka, Japan
Nobuhiko Haga, PhD, MD
,
Department of Rehabilitation Medicine, Gaduate School of Medicine, University of Tokyo, Professor, Tokyo, Japan
Hiromi Sanada, PhD, RN, WOCN
,
Department of Wound Care Management/Grontological Nursing, Graduate School of Medicine, University of Tokyo, Professor, Tokyo, Japan
Background Pressure ulcers heals with acute inflammatory response in normal wound healing process, however some would stop to heal due to prolonged inflammation despite optimal wound treatment, which does not present typical inflammatory manifestation. For promoting the wound healing, the indicator of non-healing pressure ulcers for early detection is required. We investigated the possible usefulness of wound temperature measurement by thermography since the inflammation could increase the wound temperature.Methods We recruited patients with stage II to IV pressure ulcers on body trunk, who received thermographical measurement on initial pressure ulcer round and were followed up at least three weeks, in this cohort study. The thermography was recorded immediately after gentle removal of dressings. A pressure ulcer with lower temperature in wound site than periwound skin was classified as low temperature group, and higher as high temperature group. Pressure ulcers with wound area reduction after three weeks follow up was considered as normal healing, with no changes or increase in wound area with optimal treatment as non-healing without inflammatory manifestation, and with typical infectious manifestations as infection. The study protocol was approved by local ethical committee.
Results In 35 patients, 23 showed low temperature and 12 showed high. The 22 pressure ulcers healed normally, 11 did not heal, and 2 were infected. DESIGN score, which provide gross wound status, did not differ in any subscales between healing and non-healing groups. The relative risk in high temperature for non-healing was 4.35 (95% confidence intervals; 1.25-15.17, P=0.021). The sensitivity was 0.91, specificity was 0.73, and positive predictive value was 0.87.
Discussion We could classify the normal and non-healing pressure ulcers by using thermography. In non-healing wound, the bacteria-induced inflammatory response is a possible cause of temperature increase, which might be a critical colonization. Future research is needed to establish the easy and feasible method to identify the higher temperature in wound area for clinical usefulness.
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