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Background: The assessment of chronic wounds such as digital ulcers (DUs) in systemic sclerosis relies heavily on visual aspects. However, inter-rater variability in the assessment and definition of digital ulcers is low and there are no evidence-based data concerning the visual assessment of digital ulcersa. Objectives: We analysed gaze pattern data in order to evaluate differences in the visual assessment of digital ulcers in systemic sclerosis patients. Methods: We analysed gaze pattern data from 36 subjects: 9 expert medical professionals (EMP), 8 non-expert medical professionals (NEMP), 9 medical graduates (MG) and 10 lay persons (novices). Assessment was done using a mobile eye-tracking device that tracks eye movements of subjects. Twenty pictures from digital ulcers of SSc patients were presented to each subject, 30 seconds each and characteristics of gaze pattern data were analysed. The analysis comprised the scan path, the dwell times (for areas of interest, AOI), fixation counts and the entry time for each picture and subject. Areas of interest were defined as the wound ground, wound margin, wound surroundings and distracting and non-relevant parts of the pictures. The visual assessment of the digital ulcers was accompanied by questions for each subject about their assessment of the DUs, the expected healing of the ulcer, the medical treatment of the patient. Results: Most significant differences were found between novices and medically educated groups (expert medical professionals, non-expert medical professionals, medical graduates - EMP, NEMP, MG). Dwell times in the wound area for novices differed statistically significant from all medically educated groups (1.76s-3.1s less). Above all, novices had lower dwell times in wound margin and wound surrounding and spent more time in areas with other distracting features of the picture and white space (up to 1.92s longer). Correspondingly, they had less fixation points and longer overall scan paths in wound areas. Similar gaze pattern data were observed for medically educated groups, however NEMP had a statistically significantly lower dwell time in the wound area than EMP. Questionnaire responses were compared to an expert opinion (gold standard) and EMP had significantly more correct answers on prognosis and treatment than MG for wound assessment, but not better than NEMP. However, treatment and prognosis were best in the EMP group with statistical difference to the NEMP and MG group. Conclusion: For the first time, we provide evidence-based data on the visual assessment of digital ulcers in SSc. These data will be useful for the development of a structured educational programme for young physicians, rheumatology trainees and medical graduates. A key finding is that the visual assessment of digital ulcers should increasingly emphasize the importance of pathologic changes in the wound margin and surrounding area of the wound. Hence a structured approach should focus on all areas of the wound while discarding distracting visual information. An adequate terminology should be used alongside. Reference [1] Hughes M et al., J Scleroderma Relat Disord. 2018 Jun 1;3(2):170-174. Disclosure of Interests: Thomas Moser: None declared, Quentin Lohmeyer: None declared, Mirko Meboldt: None declared, Oliver Distler Grant/research support from: Prof. Distler received research funding from Actelion, Bayer, Boehringer Ingelheim and Mitsubishi Tanabe to investigate potential treatments of scleroderma and its complications, Consultant for: Prof. Distler has/had consultancy relationship within the last 3 years with Actelion, AnaMar, Bayer, Boehringer Ingelheim, ChemomAb, espeRare foundation, Genentech/Roche, GSK, Inventiva, Italfarmaco, iQvia, Lilly, medac, MedImmune, Mitsubishi Tanabe Pharma, Pharmacyclics, Novartis, Pfizer, Sanofi, Serodapharm and UCB in the area of potential treatments of scleroderma and its complications. In addition, he had/has consultancy relationship within the last 3 years with A. Menarini, Amgen, Abbvie, GSK, Mepha, MSD, Pfizer and UCB in the field of arthritides and related disorders, Mike O. Becker: None declared |
