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, WILLMOTT, Jon, DAVIES, Matthew, KILNER, Karen, OUSEY, Karen, SOLTANI, Hora, MADHUVRATA, Priya and STEPHENSON, John (2019). 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. Antimicrobial resistance and infection control, 8 (7).

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Abstract

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. 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. Fifty-three women aged 21-44 years with BMI 30.1-43.9 Kg.m 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%. 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.

Item Type:	Article
Additional Information:	** From PubMed via Jisc Publications Router **Journal IDs: eissn 2047-2994 **Article IDs: pubmed: 30637101; pii: 461; pmc: PMC6323776 **History: accepted 27-12-2018; submitted 27-09-2018
Uncontrolled Keywords:	Antibiotics, Caesarean section, Infrared thermography, Obesity, Prognosis, Surgical site infection, Thermal mapping
Identification Number:	https://doi.org/10.1186/s13756-018-0461-7
SWORD Depositor:	Margaret Boot
Depositing User:	Margaret Boot
Date Deposited:	01 Feb 2019 10:22
Last Modified:	18 Mar 2021 06:34
URI:	https://shura.shu.ac.uk/id/eprint/23912

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