Intra- and inter-examiner reliability of digital images of skin donor areas in burns

Assunção, Flávia Fernanda de Oliveira; Gomes, Rosana Caetano; Borges, Nathália Cristina de Souza; Murta Junior, Luiz Otávio; Farina Júnior, Jayme Adriano; Guirro, Elaine Caldeira de Oliveira; Guirro, Rinaldo Roberto de Jesus

doi:10.1590/1806-9282.20210982

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Original Article • Rev. Assoc. Med. Bras. 68 (3) • Mar 2022 • https://doi.org/10.1590/1806-9282.20210982 linkcopy

Intra- and inter-examiner reliability of digital images of skin donor areas in burns

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: The main objective of this study was to evaluate intra- and inter-rater reliability in the analysis of digital images of donor areas for skin in burn patients using the CaPAS plugin in the ImageJ^®.

METHODS: Donor sites were reviewed by two independent reviewers in duplicate. The capture of images was standardized on the same device and distance (with a millimeter ruler), without a flash. The evaluators were trained to capture the images and use the plugin.

RESULTS: We selected 70 images from donor areas, from men and women between 18 and 60 years old. In the analysis of intra-examiner reliability, eight of the nine variables exhibited excellent reliability (0.985–0.998) and one (entropy) exhibited good reliability (0.525). The same was true for the inter-examiner analysis: excellent reliability for eight variables (0.824–0.993) and good reliability for entropy (0.501).

CONCLUSIONS: The CaPAS plugin has proven to be a reliable tool for use in research in skin donor areas in burns, as demonstrated by its excellent intra- and inter-examiner reliability values. This is a pioneering study in the quantitative assessment of skin donor areas in burn patients using the CaPAS plugin.

KEYWORDS:
Reproducibility of results; Data accuracy; Burns

Variables	Evaluator 1		Evaluator 2
Variables	Test	Retest	Test	Retest
Count	490,280 (361,584)	480,188 (369,297)	447,302 (342,365)	453,803 (349,364)
Mean	0.73 (0.23)	0.73 (0.22)	0.72 (0.23)	0.72 (0.23)
Standard deviation	0.53 (0.16)	0.52 (0.16)	0.52 (0.17)	0.52 (0.16)
Skewness	−0.76 (0.03)	−0.76 (0.02)	−0.75 (0.05)	−0.76 (0.03)
Kurtosis	0.60 (0.05)	0.60 (0.05)	0.62 (0.16)	0.60 (0.05)
Energy	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
Inertia	0.04 (0.03)	0.04 (0.03)	0.05 (0.07)	0.05 (0.04)
Entropy	8.99 (0.60)	9.00 (0.61)	8.97 (0.64)	8.86 (1.18)
Homogeneity	0.95 (0.03)	0.95 (0.03)	0.95 (0.03)	0.95 (0.03)

Variables		ICC	95%CI	SEM (%)	MDC (pixels)
Intra-rater
	Count	0.997	0.995–0.998	4.13	55,481.56
	Mean	0.998	0.996–0.998	1.40	0.03
	Standard deviation	0.997	0.996–0.998	1.66	0.02
	Skewness	0.991	0.986–0.995	0.38	0.01
	Kurtosis	0.992	0.987–0.995	0.86	0.01
	Energy	0.989	0.982–0.993	8.93	0.00
	Inertia	0.980	0.967–0.987	11.28	0.02
	Entropy	0.525	0.236–0.705	4.67	1.17
	Homogeneity	0.985	0.976–0.991	0.41	0.01
Inter-rater
	Count	0.983	0.972–0.989	10.03	129,864.35
	Mean	0.993	0.989–0.996	2.68	0.05
	Standard deviation	0.993	0.988–0.995	2.59	0.04
	Skewness	0.985	0.975–0.990	0.48	0.01
	Kurtosis	0.987	0.980–0.992	1.09	0.02
	Energy	0.824	0.717–0.891	35.53	0.00
	Inertia	0.895	0.831–0.935	26.35	0.04
	Entropy	0.501	0.197–0.690	7.11	1.76
	Homogeneity	0.903	0.843–0.939	1.06	0.03

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[TFN1] Data expressed as mean (standard deviation).