ABSTRACT
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 II+ 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 II+ 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 ratio=1.32 for every 100 DPU increase, p=0.03). 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.
Subject(s)
Erythema/diagnosis , Pressure Ulcer/diagnosis , Skin/metabolism , Aged, 80 and over , Body Water/metabolism , Cohort Studies , Diagnosis, Differential , Erythema/pathology , Female , Humans , Male , Nursing Homes , Physical Examination , Pressure Ulcer/pathology , Skin/pathologyABSTRACT
OBJECTIVES: To examine the relationship between a measure of subepidermal moisture (SEM) and visual skin assessment (VSA) of erythema and Stage 1 pressure ulcers (PUs) performed a week later in nursing home (NH) residents. DESIGN: Descriptive, cohort study. SETTING: Two NHs. PARTICIPANTS: Thirty-five residents. METHODS: Concurrent VSAs and SEM readings were obtained at the sacrum, right and left trochanters, buttocks, and ischial tuberosities weekly for 52 weeks. SEM was measured using a handheld dermal phase meter, with higher readings indicating greater SEM (range 0-999 dermal phase units [DPUs]). VSA was rated as normal, erythema/Stage 1 PU, or Stage 2+PU. SEM was modeled as a predictor of VSA of erythema and PUs 1 week later (controlling for clustering), with concurrent moisture, Braden Scale PU risk status, anatomic site, and ethnicity as covariates. RESULTS: Participants had a mean age of 84.7, 83% were female, and 80% were non-Hispanic white. SEM measures were lowest for normal skin (97+/-122 DPU), higher for erythema/Stage 1 PUs (192+/-188 DPU), and highest for Stage 2+PUs (569+/-320 DPU) across all sites (all P<.001). SEM was responsive to changes in VSA, and higher SEM predicted greater likelihood of erythema/Stage 1 PU the next week (odds ratio=1.26 for every 100-DPU increase in SEM, P=.04). CONCLUSION: SEM measures are associated with concurrent erythema and PUs and future (1 week later) development of erythema/Stage 1 PUs. SEM may assist in predicting early PU damage, allowing for earlier intervention to prevent skin damage.
