Objective Image-based Analysis of Leg ulcers - A Pilot Study

The clinical appearance of leg ulcers is an important factor in the clinical assessment of healing progress. Digital imaging techniques, being objective and reproducible, have advantages over human assessment of wounds. In this cross-sectional, prospective study, conducted in a teaching hospital in Western India, images of 45 chronic leg ulcers were obtained using a digital camera to objectively analyze ulcer images with the help a software system. The clinical state of ulcers was documented by a wound score by the first observer and the readings of Red-Yellow-Black-Pink components of the ulcer-images were taken using ImageJ software by the second observer. The data were analyzed using appropriate statistical tests. The leg ulcers were classified clinically into four categories: Healing, Inflamed, Slough and Necrotic, as per Applied Wound Management assessment tool. The clinical score and Red-Yellow-Black-Pink colour analysis using ImageJ were obtained. The inter-rater analysis using linear weighted kappa (K) was highly significant (K=0.833; 95% CI: 0.709 to 0.957), indicating excellent agreement. The results from this pilot study suggest that digital imaging technique has the potential to objectively process digital images of chronic ulcers.