Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes

Abstract

We examined subepidermal moisture (SEM) and visual skin assessment of heel pressure injury (PrI) among 417 nursing home residents in 19 facilities over 16 weeks. Participants were older (mean age 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, 21% Hispanic), and at risk for PrI (mean Braden Scale Risk score = 15.6). Blinded concurrent visual assessments and SEM measurements were obtained at heels weekly. Visual skin damage was categorised as normal, erythema, stage 1 PrI, deep tissue injury (DTI) or stage 2 or greater PrI. PrI incidence was 76%. Off-loading occurred with pillows (76% of residents) rather than heel boots (21%) and often for those with DTI (91%). Subepidermal moisture was measured with a device where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with normal skin values significantly different from values in the presence of skin damage. Subepidermal moisture was associated with concurrent damage and damage 1 week later in generalised multinomial logistic models adjusting for age, diabetes and function. Subepidermal moisture detected DTI and differentiated those that resolved, remained and deteriorated over 16 weeks. Subepidermal moisture may be an objective method for detecting PrI.

Reliability of the Bates‐Jensen wound assessment tool for pressure injury assessment: The pressure ulcer detection study

“…As skin color surrounding the wound increased in severity (typically demonstrating more tissue destruction below the skin surface), subepidermal moisture values also decreased. This is similar to findings using subepidermal moisture values to detect PrI where values have been reported as lower for deep tissue injury …”

“…Specifically, lower reliability estimates for persons with medium and dark skin tones suggest the need for education targeted at identification of wound characteristics among persons of color . The slightly lower reliability estimates for heel PrI may indicate a need for refining descriptors of macroscopic wound characteristics for PrI on heels . The less than optimal reliability estimates for stage 2 PrIs and DTIs may be related to difficulty in assessing skin discoloration reflective of DTIs and problems differentiating moisture associated skin damage from stage 2 PrI …”

“…45 The slightly lower reliability estimates for heel PrI may indicate a need for refining descriptors of macroscopic wound characteristics for PrI on heels. [46][47][48] The less than optimal reliability estimates for stage 2 PrIs and DTIs may be related to difficulty in assessing skin discoloration reflective of DTIs and problems differentiating moisture associated skin damage from stage 2 PrI. 49,50 The BWAT ICCs indicate lower levels of agreement, with single observer ICCs in the fair agreement range.…”

The prevalence of pressure ulcers in community‐dwelling older adults: A study in an Indonesian city

“…24,25 This scale has been used in several Asian countries as a screening instrument for PU risk, 16,26,27 both in the hospital and in the community setting. 14,26,28 The validity and reliability of the Indonesian version of the Braden Scale have been confirmed. 22 The Braden scale measures six items: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.…”

“…To assess a participants' risk of PUs, the Braden scale was used . This scale has been used in several Asian countries as a screening instrument for PU risk, both in the hospital and in the community setting . The validity and reliability of the Indonesian version of the Braden Scale have been confirmed .…”