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Racial and Ethnic Health Disparities"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Underrepresentation of diverse skin tones in medical education and providers\u2019 implicit racial bias drives inequities in wound care, such as disproportionally poor outcomes for Black patients. Diagnostic indicators (e.g., erythema) can present differently depending on skin pigmentation. This post hoc analysis of 350 chronic wounds from a prospective 14-site clinical trial aimed to determine how the perception of clinical signs and symptoms of infection (CSS) differs by patient skin tone and if fluorescence-imaging can offer a more objective diagnostic solution. Participants were grouped by skin tone (low, medium, high) as measured by the Fitzpatrick Skin Phototype Classification (FSPC) scale. CSS and total bacterial load (TBL) were compared across FSPC groups, along with sensitivity to detect TBL &gt;10\n                    <jats:sup>4<\/jats:sup>\n                    CFU\/g using CSS alone and combined with fluorescence-imaging. Erythema was reported less often with increasing FSPC score (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.05), from 13.4% (low), to 7.2% (medium), to 2.3% (high), despite comparable bacterial loads (median = 1.8 \u00d7 10\n                    <jats:sup>6<\/jats:sup>\n                    CFU\/g). CSS sensitivity in the high group (2.9%) was 4.8-fold to 8.4-fold lower than the low (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.003) and medium groups (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.04). Fluorescence-imaging significantly improved the detection of high bacterial load in each group, peaking in the high group at 12-fold over CSS alone. These findings underscore the threat of pervasive racialized health inequities in wound care, where missed diagnosis of pathogenic bacteria and infection could delay treatment, increasing the risk of complications and poor outcomes. Fluorescence-imaging is poised to fill this gap, at least in part, serving as a more objective and equitable indicator of wound bacteria.\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link>\n                    #NCT03540004 registered 16-05-2018.\n                  <\/jats:p>","DOI":"10.1007\/s40615-023-01584-8","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T10:41:44Z","timestamp":1681209704000},"page":"1045-1055","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Skin Pigmentation Impacts the Clinical Diagnosis of Wound Infection: Imaging of Bacterial Burden to Overcome Diagnostic Limitations"],"prefix":"10.1007","volume":"11","author":[{"given":"Jonathan","family":"Johnson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Alton R.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha R.","family":"Kelso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisha R.","family":"Oropallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1032-3578","authenticated-orcid":false,"given":"Thomas E.","family":"Serena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,11]]},"reference":[{"key":"1584_CR1","doi-asserted-by":"publisher","DOI":"10.24376\/rd.sgul.12769988.v1","volume-title":"Mind the gap: a handbook of clinical signs in black and brown skin (Version 1)","author":"M Mukwende","year":"2020","unstructured":"Mukwende M, Tamony P, Turner M. 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