The objective of this descriptive cohort study was to examine the relationship between subepidermal moisture (SEM) and visual assessment of early pressure ulcers (PUs) in 31 nursing home (NH) residents residing in two NHs. Concurrent visual assessments and SEM were obtained at the sacrum, right and left trochanters, buttocks, and ischium weekly for 20 weeks. Visual assessment was rated as normal, erythema, stage I PU, or stage II1 PU. SEM, measured with a dermal phase meter where higher readings indicate greater SEM (range: 0-999 dermal phase units [DPU]), was modeled as a predictor of concurrent visual assessment of skin damage and erythema and stage I PUs at the sacrum 1 week later with covariate PU risk. Participants had a mean age of 84.1 years, were 83% female, 72% non-Hispanic white. SEM was lowest for normal skin (104 DPU, SD 114), higher for erythema (185 DPU, SD 138), stage I PUs (264 DPU, SD 208), and highest for stage II1 PUs (727 DPU, SD 287) across all sites (all p < 0.01). SEM was responsive to visual assessment changes, differentiated between erythema and stage I PU, and higher SEM predicted greater likelihood of erythema/stage I PU at the sacrum the next week (odds ratio51.32 for every 100 DPU increase, p50.03). SEM was associated with concurrent skin damage and future (1 week later) development of sacral erythema/stage I PUs. SEM differentiates between erythema and stage I PUs. SEM may assist in predicting early PU damage, allowing for earlier intervention to prevent PUs.

OBJECTIVE To examine the relationship between a measure of skin and tissue water, sub-epidermal skin moisture (SEM), and visual assessment of early PU damage in nursing home (NH) residents with dark skin tones. DESIGN, SETTING AND PARTICIPANTS Descriptive, cohort study with 66 residents in four U.S. nursing homes (NH). METHODS Data were pooled from two previous NH studies to evaluate persons with dark skin tones. Data were analyzed for concurrent visual assessments and SEM which were obtained at the right and left buttocks and sacrum weekly for 20 weeks. SEM was measured with a surface electrical capacitance dermal phase meter, where higher readings indicate greater SEM (range: 0-999 dermal phase units [DPU]). Visual assessment was rated as normal, erythema/stage I PU, or stage II+ PU. SEM and specific SEM threshold values (50, 150, 300 DPU) were modeled as detectors of visual assessment of early PU one week later (controlling for clustering and incontinence); with concurrent SEM, and PU risk status, in separate analyses for persons with light and dark skin tones. RESULTS Participants had a mean age of 84 years, were 83% female, 77% non-Hispanic white. Higher SEM predicted greater likelihood of erythema/stage I PU and stage II+ PU in persons with dark skin tones the next week (OR=1.88 for every 100 DPU increase in SEM, p=0.004). When SEM was greater than 50, 150, and 300 DPU, persons with dark skin tones were 8.5, 13, and 10 times more likely to present with stage II+ PU the following week compared to persons with light skin who were 7.2, 3.5, and 4.3 times more likely to present with stage II PU (50, 150, 300 DPU, respectively). SEM threshold of 50 DPU was also significant for detecting erythema/stage I PU in persons with dark skin tones (OR 5.3, CI 1.87—15.11, P<.001). CONCLUSIONS SEM was associated with future (one week later) PU in persons with dark skin tones. SEM threshold values may assist in detecting early PU in persons with dark skin tones, allowing for earlier intervention to prevent PU. These findings should be further evaluated in persons with dark skin tones.