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A Comparison of 3 Wound Measurement Techniques: Effects of Pressure Ulcer Size and Shape

Bilgin, Mehtap; Güneş, Ülkü Yapucu

Journal of Wound, Ostomy & Continence Nursing: November/December 2013 - Volume 40 - Issue 6 - p 590–593
doi: 10.1097/01.WON.0000436668.79024.f9
Wound Care

PURPOSE: The aim of this study was to examine the levels of agreement among 3 techniques used in wound measurement comparing more spherical versus irregularly shaped wounds.

DESIGN: The design of this study is evaluative research.

SUBJECTS AND SETTING: Sixty-five consecutive patients with 80 pressure ulcers of various sizes referred from a university hospital in Izmir, Turkey, were evaluated.

METHODS: The 80 pressure ulcers identified on the 65 participants were divided into 2 groups based on pressure ulcer shape and wound surface area. Twenty-four of the 80 ulcers (30%) were characterized as irregularly shaped and greater than 10 cm2. Fifty-six were regularly shaped (approximating a circle) and less than 10 cm2. Pressure ulcer areas were measured using 3 techniques: measurement with a ruler (wound area was calculated by measuring and multiplying the greatest length by the greatest width perpendicular to the greatest length), wound tracing using graduated acetate paper, and digital planimetry. The level of agreement among the techniques was explored using the intraclass correlation coefficient (ICC).

RESULTS: Strong agreement was observed among the techniques when assessing small, more regularly shaped wounds (ICC = 0.95). Modest agreement was achieved when measuring larger, irregularly shaped wounds (ICC = 0.70).

CONCLUSION: Each of these techniques is adequate for measuring surface areas of smaller wounds with an approximately circular shape. Measurement of pressure ulcer area via the ruler method tended to overestimate surface area in larger and more irregularly shaped wounds when compared to acetate and digital planimetry. We recommend digital planimetry or acetate tracing for measurement of larger and more irregularly shaped pressure ulcers in the clinical setting.

Mehtap Bilgin, MSc, Registered Nurse, Ege University Faculty of Medicine, Department of Thoracic & Cardiovascular Surgery, Bornova, Izmir, Turkey.

Ülkü Yapucu Güneş, PhD, Associated Professor, Ege University Faculty of Nursing, Bornova, Izmir, Turkey.

Correspondence: Ülkü Yapucu Güneş, Ege University Faculty of Nursing, Bornova, Izmir, Turkey (

The authors declare no conflict of interest.

© 2013 by the Wound, Ostomy and Continence Nurses Society.