Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 16 , ISSUE 1 ( January-April, 2021 ) > List of Articles

Original Article

Intrarater Reliability of Digital Thermography in Detecting Pin Site Infection: A Proof of Concept Study

Ole Rahbek, Hans-Christen Husum, Marie Fridberg, Arash Ghaffari, Søren Kold

Keywords : FLIR C3 camera, Inter-rater/Intrarater reliability, Modified Gordon Pin Infection Classification, Pin site infection, Proof-of-concept study, Thermography

Citation Information :

DOI: 10.5005/jp-journals-10080-1522

License: CC BY-NC-SA 4.0

Published Online: 00-04-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: The purpose of this study was to explore the capability and Intrarater reliability of thermography in detecting pin site infection. Materials and methods: This is an explorative proof of concept study. Clinical assessment of pin sites was performed by one examiner with the Modified Gordon Pin Infection Classification from grade 0 to 6. Thermography of the pin sites was performed with a FLIR C3 camera. The analysis of the thermographic images was done in the software FLIR Tools. The maximum skin temperature around the pin site and the maximum temperature for the whole thermographic picture were measured. An Intrarater agreement was established and test-retests were performed with different camera angles. Results: Thirteen (four females, nine males) patients (age 9–72 years) were included. Indications for frames: Fracture (n=4), two deformity correction, one lengthening and six bone transport. Days from surgery to thermography ranged from 27 to 385 days. Overall, 231 pin sites were included. Eleven pin sites were diagnosed with early signs of infection: five grade 1, five grade 2 and one grade 3. Mean pin site temperature for each patient was calculated, varied between patients from 29.0°C to 35.4°C (mean 33.9°C). With 34°C as cut-off value for infection, sensitivity was 73%; specificity, 67%; positive predictive value, 10%; and negative predictive value, 98%. Intrarater agreement for thermography was ICC 0.85 (0.77–0.92). The temperature measured was influenced by the camera positioning in relation to the pin site with a variance of 0.2. Conclusions: Measurements of pin site temperature using the hand-held FLIR C3 infrared camera was a reliable method and the temperature was related to infection grading. Clinical significance: This study demonstrated that digital thermography with a hand-held camera might be used for monitoring the pin sites after operations to detect early infection.


PDF Share
  1. Potgieter MS, Pretorius HS, Preez GD, et al. Complications associated with hexapod circular fixation for acute fractures of the tibia diaphysis: a retrospective descriptive study at a high volume trauma centre. Injury 2020;51(2):516–521. DOI: 10.1016/j.injury.2019.11.012.
  2. Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strateg Trauma Limb Reconstr 2016;11(2):75–85. DOI: 10.1007/s11751-016-0256-4.
  3. Ceroni D, Grumetz C, Desvachez O, et al. From prevention of pin-tract infection to treatment of osteomyelitis during paediatric external fixation. J Child Orthop 2016;10(6):605–612. DOI: 10.1007/s11832-016-0787-8.
  4. Lethaby A, Temple J, Santy-Tomlinson J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database Syst Rev 2013;12:CD004551. DOI: 10.1002/14651858.CD004551.pub3.
  5. Fragomen AT, Miller AO, Brause BD, et al. Prophylactic postoperative antibiotics may not reduce pin site infections after external fixation. HSS J 2017;13(2):165–170. DOI: 10.1007/s11420-016-9539-z.
  6. Ring FJ. Pioneering progress in infrared imaging in medicine. Quant Infrared Thermogr J 2014;11(1):57–65. DOI: 10.1080/17686733.2014.892667.
  7. Christensen J, Matzen LH, Vaeth M, et al. Thermography as a quantitative imaging method for assessing postoperative inflammation. Dentomaxillofac Radiol 2012;41(6):494–499. DOI: 10.1259/dmfr/98447974.
  8. Martínez-Jiménez MA, Ramirez-Garcia Luna JL, Kolosovas-Machuca ES, et al. Development and validation of an algorithm to predict the treatment modality of burn wounds using thermographic scans: prospective cohort study. PLoS One 2018;13(11):e0206477. DOI: 10.1371/journal.pone.0206477.
  9. Xue EY, Chandler LK, Viviano SL, et al. Use of FLIR ONE smartphone thermography in burn wound assessment. Ann Plast Surg 2018;80(4):S236–S238. DOI: 10.1097/SAP.0000000000001363.
  10. Carrière ME, de Haas LEM, Pijpe A, et al. Validity of thermography for measuring burn wound healing potential. Wound Repair Regen 2019;2019:347–354. DOI: 10.1111/wrr.12786.
  11. Childs C, Wright N, Willmott J, et al. 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. Antimicrob Resist Infect Control 2019;8(1):7. DOI: 10.1186/s13756-018-0461-7.
  12. Romanò CL, Romanò D, Dell’Oro F, et al. Healing of surgical site after total hip and knee replacements show similar telethermographic patterns. J Orthop Traumatol 2011;12(2):81–86. DOI: 10.1007/s10195-011-0135-1.
  13. John HE, Niumsawatt V, Rozen WM, et al. Clinical applications of dynamic infrared thermography in plastic surgery: a systematic review. Gland Surg 2016;5(2):122–132. DOI: 10.3978/j.issn.2227-684X.2015.11.07.
  14. Fierheller M, Sibbald RG. A clinical investigation into the relationship between increased periwound skin temperature and local wound infection in patients with chronic leg ulcers. Adv Skin Wound Care 2010;23(8):369–379. DOI: 10.1097/01.ASW.0000383197.28192.98.
  15. Cwajda‐Białasik J, Mościcka P, Jawień A, et al. Infrared thermography to prognose the venous leg ulcer healing process—preliminary results of a 12‐week, prospective observational study. Wound Repair Regen 2020;28(2):224–233. DOI: 10.1111/wrr.12781.
  16. Aliahmad B, Tint AN, Poosapadi Arjunan S, et al. Is thermal imaging a useful predictor of the healing status of diabetes-related foot ulcers? A pilot study. J Diabetes Sci Technol 2019;13(3):561–567. DOI: 10.1177/1932296818803115.
  17. Ring EFJ, Ammer K. Infrared thermal imaging in medicine. Physiol Meas 2012;33(3):R33–R46. DOI: 10.1088/0967-3334/33/3/R33.
  18. Kottner J, Audige L, Brorson S, et al. Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. Int J Nurs Stud 2011;48(6):661–671. DOI: 10.1016/j.ijnurstu.2011.01.016.
  19. Gordon JE, Kelly-Hahn J, Carpenter CJ, et al. Pin site care during external fixation in children: results of a nihilistic approach. J Pediatr Orthop 2000;20(2):163–165. DOI: 10.1097/01241398-200003000-00006.
  20. Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma 2003;17(7):503–507. DOI: 10.1097/00005131-200308000-00005.
  21. Uematsu S, Jankel WR, Edwin DH, et al. Quantification of thermal asymmetry. Part 2: application in low-back pain and sciatica. J Neurosurg 1988;69(4):556–561. DOI: 10.3171/jns.1988.69.4.0556.
  22. Thomas D, Cullum D, Siahamis G, et al. Infrared thermographic imaging, magnetic resonance imaging, CT scan and myelography in low back pain. Rheumatology 1990;29(4):268–273. DOI: 10.1093/rheumatology/29.4.268.
  23. Takahashi Y, Takahashi K, Moriya H. Thermal deficit in lumbar radiculopathy: correlations with pain and neurologic signs and its value for assessing symptomatic severity. Spine 1994;19(21):2443–2448. Available at: https://pubmed.ncbi.nlm.nih.gov/7846599/
  24. Wasner G, Schattschneider J, Baron R. Skin temperature side differences - a diagnostic tool for CRPS? Pain 2002;98(1–2):19–26. DOI: 10.1016/s0304-3959(01)00470-5.
  25. Huygen FJPM, Niehof S, Klein J, et al. Computer-assisted skin videothermography is a highly sensitive quality tool in the diagnosis and monitoring of complex regional pain syndrome type 1. Eur J Appl Physiol 2004;91(5–6):516–524. DOI: 10.1007/s00421-003-1037-6.
  26. Niehof SP, Huygen FJPM, van der Weerd RWP, et al. Thermography imaging during static and controlled thermoregulation in complex regional pain syndrome type 1: diagnostic value and involvement of the central sympathetic system. Biomed Eng Online 2006;5:30. DOI: 10.1186/1475-925X-5-30.
  27. So YT, Aminoff MJ, Olney RK. The role of thermography in the evaluation of lumbosacral radiculopathy. Neurology 1989;39(9):1154–1158. DOI: 10.1212/wnl.39.9.1154.
  28. Hoffman RM, Kent DL, Deyo RA. Diagnostic accuracy and clinical utility of thermography for lumbar radiculopathy a meta-analysis. Spine 1991;16(6):623–628. DOI: 10.1097/00007632-199106000-00005.
  29. Sherman RA, Karstetter KW, Damiano M, et al. Stability of temperature asymmetries in reflex sympathetic dystrophy over time and changes in pain. Clin J Pain 1994;10(1):71–77. DOI: 10.1097/00002508-199403000-00010.
  30. Leclaire R, Esdaile JM, Jéquier JC, et al. Diagnostic accuracy of technologies used in low back pain assessment: thermography, triaxial dynamometry, spinoscopy, and clinical examination. Spine 1996;21(11):1325–1331. DOI: 10.1097/00007632-199606010-00009.
  31. Lahiri BB, Bagavathiappan S, Jayakumar T, et al. Medical applications of infrared thermography: a review. Infrared Phys Technol 2012;55(4):221–235. DOI: 10.1016/j.infrared.2012.03.007.
  32. Nguyen AV, Cohen NJ, Lipman H, et al. Comparison of 3 infrared thermal detection systems and self-report for mass fever screening. Emerg Infect Dis 2010;16(11):1710–1717. DOI: 10.3201/eid1611.100703.
  33. Schmidt M, Lahrmann KH, Ammon C, et al. Assessment of body temperature in sows by two infrared thermography methods at various body surface locations. J Swine Heal Prod 2013;21(4):203–209. Available at: https://www.aasv.org/shap.html
  34. Liu L, Gisselman AS, Tumilty S. Thermal profiles over the Patella tendon in a cohort of non-injured collegiate athletes over the course of a cross-country season. Phys Ther Sport 2020;44:47–52. DOI: 10.1016/j.ptsp.2020.04.034.
  35. Obinah MPB, Nielsen M, Hölmich LR. High-end versus low-end thermal imaging for detection of arterial perforators. Plast Reconstr Surg 2020;10:e3175. DOI: 10.1097/GOX.0000000000003175.
  36. Kost GJ, Tran NK, Louie RF. Point-of-care testing: principles, practice, and critical-emergency-disaster medicine. In: Encyclopedia of analytical chemistry. Chichester: John Wiley & Sons, Ltd, 2008.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.