Handy measurements: calibrating clinicians' wound size estimation for remote referral pathways

Accurate documentation of wound size influences referral decisions and operative planning. As remote pathways such as the Virtual Fracture Clinic rely increasingly on documented descriptions without accompanying photographs, inaccurate estimation risks misclassification and unnecessary procedures. This study assessed baseline accuracy of clinician wound-size estimation, the effect of a hand-based measurement intervention and the relationship between confidence and accuracy.

A prospective interventional study was conducted across two NHS hospitals in Sussex, England. Seventy clinical staff of all grades and specialties answered a questionnaire and estimated the length of five true-scale simulated wounds (1.6-16.1cm), first using their usual method and then using their own finger widths as a reference. Cumulative absolute error (CAE) was compared pre- and postintervention using the Wilcoxon signed-rank test, with rank-biserial correlation for effect size.

Median CAE fell from 6.60cm to 2.95cm, a 55.3% reduction (p<0.001, r=0.86), with significant improvement for every wound and in 85.7% of participants. The benefit was consistent across all specialties and seniority levels. Preintervention, estimates skewed toward overestimation. Neither seniority (Spearman ρ=0.02, p=0.87) nor self-reported confidence (ρ=-0.12, p=0.31) correlated with accuracy.

Clinicians estimate wound size poorly regardless of experience, and confidence does not reflect competence. Estimates made using one's hand as a ruler were significantly more accurate across all three specialty groups, offering a low-cost, readily available means of improving referral quality. Future work should assess durability and performance on real wounds.