The surgical wound in infrared

thermographic profiles and early stage test-accuracy to predict surgical site infection in obese women during the first 30 days after caesarean section

Charmaine Childs, Nicola Wright, Jon Wilmott, Matthew Davies, Karen Kilner, Karen Ousey, Hora Soltani, Priya Madhuvrata, John Stephenson

Research output: Contribution to journalArticle

Abstract

Background: Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI). Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods: IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman's community physician with logistic regression models derived to model dichotomous outcomes. Results: Fifty-three women aged 21-44 years with BMI 30.1-43.9 Kg.m - 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for 'professional' opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%; Conclusions: IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.

Original languageEnglish
Article number7
Pages (from-to)1-15
Number of pages15
JournalAntimicrobial Resistance and Infection Control
Volume8
DOIs
Publication statusPublished - 7 Jan 2019

Fingerprint

Surgical Wound Infection
Cesarean Section
Wounds and Injuries
Temperature
Abdomen
Logistic Models
Anti-Bacterial Agents
Surgical Wound
Women Physicians
Biomedical Technology Assessment
Wound Infection
Infection
Decision Making
Obesity
Hot Temperature
Odds Ratio
Parturition

Cite this

@article{90ff07413e044a149047dbefe3125480,
title = "The surgical wound in infrared: thermographic profiles and early stage test-accuracy to predict surgical site infection in obese women during the first 30 days after caesarean section",
abstract = "Background: Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI). Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods: IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman's community physician with logistic regression models derived to model dichotomous outcomes. Results: Fifty-three women aged 21-44 years with BMI 30.1-43.9 Kg.m - 2 were recruited. SSI rate (within 30 days) was 28{\%}. Inter-rater variability for 'professional' opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79{\%}; Conclusions: IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.",
keywords = "Surgical site infection, Obesity, Caesarean section, Prognosis, Antibiotics, Infrared thermography, Thermal mapping",
author = "Charmaine Childs and Nicola Wright and Jon Wilmott and Matthew Davies and Karen Kilner and Karen Ousey and Hora Soltani and Priya Madhuvrata and John Stephenson",
year = "2019",
month = "1",
day = "7",
doi = "10.1186/s13756-018-0461-7",
language = "English",
volume = "8",
pages = "1--15",
journal = "Antimicrobial Resistance and Infection Control",
issn = "2047-2994",
publisher = "BioMed Central",

}

The surgical wound in infrared : thermographic profiles and early stage test-accuracy to predict surgical site infection in obese women during the first 30 days after caesarean section. / Childs, Charmaine; Wright, Nicola; Wilmott, Jon; Davies, Matthew; Kilner, Karen; Ousey, Karen; Soltani, Hora; Madhuvrata, Priya; Stephenson, John.

In: Antimicrobial Resistance and Infection Control, Vol. 8, 7, 07.01.2019, p. 1-15.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The surgical wound in infrared

T2 - thermographic profiles and early stage test-accuracy to predict surgical site infection in obese women during the first 30 days after caesarean section

AU - Childs, Charmaine

AU - Wright, Nicola

AU - Wilmott, Jon

AU - Davies, Matthew

AU - Kilner, Karen

AU - Ousey, Karen

AU - Soltani, Hora

AU - Madhuvrata, Priya

AU - Stephenson, John

PY - 2019/1/7

Y1 - 2019/1/7

N2 - Background: Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI). Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods: IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman's community physician with logistic regression models derived to model dichotomous outcomes. Results: Fifty-three women aged 21-44 years with BMI 30.1-43.9 Kg.m - 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for 'professional' opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%; Conclusions: IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.

AB - Background: Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI). Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods: IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman's community physician with logistic regression models derived to model dichotomous outcomes. Results: Fifty-three women aged 21-44 years with BMI 30.1-43.9 Kg.m - 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for 'professional' opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%; Conclusions: IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.

KW - Surgical site infection

KW - Obesity

KW - Caesarean section

KW - Prognosis

KW - Antibiotics

KW - Infrared thermography

KW - Thermal mapping

UR - http://www.scopus.com/inward/record.url?scp=85059911337&partnerID=8YFLogxK

U2 - 10.1186/s13756-018-0461-7

DO - 10.1186/s13756-018-0461-7

M3 - Article

VL - 8

SP - 1

EP - 15

JO - Antimicrobial Resistance and Infection Control

JF - Antimicrobial Resistance and Infection Control

SN - 2047-2994

M1 - 7

ER -