Introduction: Predictive tools are clinically and economically significant as they help define a resource-conscious practice through individualized treatment plans that derive into better outcomes. Fluorescence imaging devices* are objective, bedside tools that can detect and localize bacterial burden in and around wounds. As the clinical evidence for this technology mounts, its predictive potential in wound care and its subsequent impact on outcomes and cost-efficiency is becoming increasingly evident. Here, we review predictive studies involving fluorescence imaging and present cases demonstrating its ability to predict wound or treatment outcomes.
Methods: A systematic literature search (PubMed/Embase) for studies or case series that employed fluorescence imaging of wound bacteria and correlated fluorescence findings with outcomes. We reviewed pertinent studies in full and recorded our observations of general themes to present a narrative review of the key applications for predictive fluorescence imaging. We supplement these descriptions with demonstrative clinical cases.
Results: We identified six published articles which fulfilled the search criteria, correlating fluorescence imaging results with outcomes, most of which provided quantitative assessments. These included case series, clinical studies, and a randomized controlled trial. The primary applications for fluorescence imaging in terms of predicting outcomes were: (1) predicting wound area reduction (WAR), (2) predicting delayed healing, and (3) predicting the success/failure of cellular and/or tissue-based products (CTPs). In general, positive presence of bacterial fluorescence signals was associated with poor outcomes (low WAR, delayed healing, CTP failure), particularly when it remained unsuccessfully treated by the end of study period. A stepwise correlation was evidenced in two studies where WAR was linked to the bacterial fluorescence status both at the outset of treatment and its eventual elimination. Clinical cases help to showcase the predictive potential of fluorescence imaging in a visual manner.
Discussion: This work represents the first assembly of literature regarding the ability of bacterial fluorescence imaging to predict wound and therapeutic outcomes. The studies reviewed present fluorescence imaging as a powerful predictive tool in wound care, with the ability to predict WAR, delayed healing, and CTP outcomes. The incorporation of fluorescence imaging in wound assessment and management improves outcomes and supports rational resource allocation and cost-efficiency.