InCISE: Instrument for Comprehensive Incisional and Surgical Evaluation. The development of a wound healing score for comprehensive, objective assessment of head and neck surgery wound healing

Abstract

Objective / Hypothesis: The evaluation of healing after head and neck surgery is currently qualitative and non-standardized, limiting the quality of surgical healing assessments in clinical and research settings. We sought to develop an objective, standardized wound assessment score and hypothesize that a reliable instrument can be developed to evaluate head and neck surgical wounds. Study type / Design: Prospective cohort study Methods: A prospective cohort study was conducted in a tertiary-care, academic head and neck surgery practice. Patients undergoing head and neck surgery were enrolled and a digital photograph protocol was developed for evaluating healing surgical wounds. A panel of experts undertook the steps of developing a wound healing score and establishing reliability of the score. Results: InCISE: Instrument for comprehensive incisional and surgical evaluation was created. The utility of our wound healing score was assessed using classical test theory. We performed the major steps of establishing reliability: 1. internal consistency (Cronbach’s alpha = 0.78), 2. inter-observer reliability (intra-class correlation = 0.64), and 3.intra-rater reliability (intra-class correlation = 0.72) and content validity (through focus groups). Our composite measure was found to have strong internal consistency, moderate inter-rater reliability, and strong intra-rater reliability. Conclusions: A wound healing score for head and neck surgery, InCISE, can be developed and is reliable. While content validity is present, additional work continues to establish criterion validity in this instrument in order to allow for clinical and research use.