Reliability of an AI-powered Application Across Different Mobile Devices for Assessment of Chronic Wounds ActAgainstAmputation #DiabeticFoot @ALPSlimb @USC @USC_vascular @ResearchatUSC @KeckSchool_USC

From our team led by super student Mark Swerdlow!

Mark Swerdlow 1Jessica Lo 2David G Armstrong 3

Objective: Evaluate the inter- and intra-rater reliability of a wound assessment tool in iPhone 12 and 13 mini modalities against a validated iPad mini/Structure Sensor configuration.

Approach: We assessed a wound measurement application (eKare inSight) for result consistency in patients presenting with wounds. Assessments were analyzed using a two-way analysis of variance (ANOVA). Intraclass Correlation Coefficient (ICC) was computed for intra-rater (ICC1,1) and inter-rater (ICC2,1) analysis using a two-way random effects model. Paired t-test assessed the statistical difference between measurement methods.

Results: Forty-two lesions were analyzed with surface areas ranging from 0.2 cm2 to 23 cm2 (average 4.33 ± 5.44 cm2). A high level of reliability was observed for repeat wound area measurements by the same examiner (ICC1,1 = 0.997) and between examiners with iPhone 13 mini (ICC2,1 = 0.998). There was no significant difference between iPhone 12 and iPad mini/Structure Sensor (p=0.78) or between iPhone 13 mini and iPhone 12 (p=0.22). Minimal difference existed between iPhone 13 mini and iPad mini/Structure Sensor (p=0.049, Cohen’s d=0.01).

Innovation: Increased pervasiveness of smartphones in clinical care, coupled with advances in smartphone imaging and machine learning, allows for a potential solution to the problem of fast and accurate wound measurements. The application investigated produces wound measurement results quickly and with demonstrated accuracy. It does not require a calibration sticker or reference marker and allows for automatic wound boundary delineation.

Conclusion: The results of this study suggest that a digital planimetry mobile application may offer high levels of reliability across devices and users.

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