A retrospective evaluation of digital wound imaging to predict response to hyperbaric oxygen treatment

As new wound care treatments become available, correct initial treatment selection and dynamic modification of regimens, based on wound response to treatment, must be applied to improve outcomes and reduce cost. One alternative is wound morphometry using digital wound images to evaluate wound response to treatment in realtime. To determine whether wound area measurements taken during the first 3 weeks of hyperbaric oxygen treatment predict eventual treatment response and how demographic and disease factors impact hyperbaric oxygen treatment response, a retrospective study using digital wound images, demographic data, and available clinical laboratory values was conducted. Participants included 29 wound care patients with nonhealing wounds of the lower extremities receiving treatment at a hyperbaric wound care facility. Conventional wound care (ie, debridement, dressing changes, and topical agents) plus hyperbaric oxygen treatment (100% oxygen breathing at 2.4 atmospheres absolute for 90 minutes) given once every weekday for up to 20 weeks was provided. Graphical analysis of normalized wound area over time revealed two groups: minimal responders (n=13) and robust responders (n=16). Minimal response was characterized by delayed onset of wound area reduction and virtual cessation of reduction by week 3. Robust response was continuous, sustained, and resulted in average wound area reduction of 80% by end of treatment, compared to 47% in minimally responsive patients. Age, blood glucose, and serum creatinine significantly affected the wound healing response to hyperbaric oxygen treatment (P<0.05). Digital images obtained during the first 3 weeks of treatment predicted if a patient is minimally responsive to hyperbaric oxygen treatment with 100% accuracy. Area measurements obtained in this manner can be used to identify patients minimally responsive to hyperbaric oxygen treatment, enabling rapid assessment of treatment response to make timely changes in therapy in order to optimize treatment outcomes.