International Delphi Consensus on the Use of Near-infrared Spectroscopy for Wound Care and Procedural Decision-making, With Adjunctive Workflow and Time Analysis.

Abstract

OBJECTIVE: Near-infrared spectroscopy (NIRS) is a point-of-care imaging modality that provides real-time measurement of tissue oxygenation and hemoglobin dynamics. Conventional vascular testing remains an essential component of wound care and limb preservation but evaluates vessel anatomy, blood flow, and other aspects of vascular status that differ from the tissue-level physiological information provided by NIRS. Although the 2 approaches may be complementary, NIRS can independently inform clinical decision-making by providing immediate physiological information at the point of care. This study employed a modified Delphi process to characterize expert perspectives regarding the clinical role, integration, workflow, and value of NIRS across wound care, tissue assessment, and related procedural settings. METHODS: A modified Delphi process was conducted with a multidisciplinary panel representing diverse specialties, practice settings, and geographic regions. Survey items addressed clinical indications, workflow integration, decision-making impact, operational considerations, and the relationship between NIRS and conventional vascular assessment. Consensus was predefined as ≥80% agreement. A supplementary workflow and time analysis was performed using a subset of experienced users to characterize procedural steps and associated time requirements. RESULTS: Survey responses generally supported confidence in vascular testing when appropriately selected, performed, and interpreted; however, the Round 1 panel discussion highlighted concerns regarding study selection, interpretation, repeat testing, and variability across testing pathways. Access and timeliness emerged as additional challenges that were consistently identified across both survey responses and the panel discussion. Delays in obtaining clinically meaningful physiological information were reported to contribute to clinically significant consequences, including hospitalization and amputation, particularly in lower-access environments. There was strong agreement that point-of-care NIRS enables earlier recognition of underlying pathophysiology and more timely initiation of appropriate interventions. NIRS was described as integrated across the continuum of care, including initial evaluation, procedural planning, treatment modification, referral support, and longitudinal monitoring. Of the 40 consensus items evaluated by the 18-member panel, 37 (92.5%) met the predefined ≥80% agreement threshold. Overall interrater agreement was very strong (median rWG: 0.92; interquartile range: 0.84 to 1.00). The supplementary workflow and time analysis demonstrated that image acquisition activities were generally efficient, whereas interpretation, documentation, reporting, and care coordination accounted for a substantial proportion of total clinician effort. CONCLUSIONS: This study identifies a clinically meaningful gap between the availability of diagnostic testing and the timely delivery of actionable physiological information within wound care workflows. Although conventional vascular testing remains essential, clinicians described challenges related to testing pathways, study selection, interpretation, access, timeliness, and integration of physiological information into clinical decision-making. Within this context, NIRS provides point-of-care physiological information and supports longitudinal monitoring of tissue oxygenation throughout treatment. By providing real-time physiological insight, NIRS may facilitate earlier recognition of deteriorating tissue status, support more timely intervention, and help bridge episodic diagnostic assessment with continuous clinical management. More broadly, these findings suggest that the value of emerging diagnostic technologies should be evaluated not only by the information they generate, but also by their ability to deliver actionable data within clinical workflows, support longitudinal monitoring, and account for the clinician effort required to interpret, integrate, document, and act upon physiological findings.

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