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Oral Abstracts (Session 5 of 5)
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(Presentation 36.2) Subepidermal moisture measures and visual skin assessment of erythema and pressure ulcers Barbara Bates-Jensen, PhD, RN, CWOCN, Heather E. McCreath; Ayumi Kono; Neil Christopher R. Apeles; Lisa Howell; Cathy Alessi Background: Visual skin assessment for erythema and Stage I pressure ulcers (PUs) is problematic in terms of accuracy, reliability, and failure to detect skin color changes in darkly pigmented skin. Yet, 75% of PUs in nursing homes are Stage I and Stage II, and it has been suggested that early PUs are more responsive to prevention interventions. If a biophysical measure of erythema and Stage I PUs was available, it would reduce problems related to detection of these lesions. No biophysical measure of early PUs in nursing home residents has been tested. Objective: The objective of this study was to examine the relationship between subepidermal moisture and direct visual skin assessment of erythema and Stage I PUs in nursing home residents. Design: This descriptive, cohort study examined 35 nursing home residents in 2 nursing homes. Methods: Visual skin assessments and subepidermal moisture readings were obtained at the sacrum, right and left trochanters, buttocks, and ischial tuberosities weekly for 52 weeks. Moisture was measured with a handheld dermal phase meter; higher readings showed greater subepidermal moisture (range: 0–999; NOVA Technology Corporation, Portsmouth, NH). Visual skin assessment was rated as normal, blanchable erythema, Stage I PU, or Stage II+ PU. Results: Subjects were typical nursing home residents: older (mean age 84.7 years), white (79%) women (85%) with some cognitive/functional impairment (mean Minimum Data Set recall score 2.14; mean Minimum Data Set activities of daily living bed mobility score 1.47) with 28 incident Stage II/Stage III PUs. Mean moisture was 107 (SD = 134) for normal skin, 183 (SD = 176) for blanchable erythema, 299 (SD = 263) for Stage I PUs, and 554 (SD = 324) for Stage II+ PUs across all sites (ANOVA F = 579.7, df = 3, P < 0.001); Scheffe post-hoc analysis showed significant pairwise differences between all groups. Conclusions: Subepidermal moisture may be useful in validating visual skin assessments of erythema and Stage I PU, allowing for earlier intervention, particularly in those with darkly pigmented skin. |
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