Scheiner J, Farid K, Raden M, Demisse S, et al.
Ostomy/wound management. Date of publication 2017 Mar 1;volume 63(3):36-46.
1. Ostomy Wound Manage. 2017 Mar;63(3):36-46.
Ultrasound to Detect Pressure-related Deep Tissue Injuries in Adults Admitted via
the Emergency Department: A Prospective, Descriptive, Pilot Study.
Scheiner J(1), Farid K, Raden M(2), Demisse S(3).
Author information:
(1)Department of Radiology and Vascular and Interventional Radiology, Staten
Island University Hospital, Staten Island, NY.
(2)Neuro-radiology, Staten Island University Hospital.
(3)Biostatistics Unit, Feinstein Institute for Medical Research, North Shore Long
Island Jewish Health System, Staten Island University Hospital-North, Staten
Island, NY.
Stage 4 pressure ulcers (PUs) start with tissue death at the level of the bone,
also known as deep tissue injury (DTI). Studies have shown the appearance of DTI
on the skin is delayed for several days after the original pressure-related
injury to the deep soft tissues. Studies also suggest DTI can be seen using
ultrasound (US) technology. A prospective, descriptive, correlational pilot study
was conducted to evaluate the use of US technology to detect DTI in the soft
tissues that are not visible on the skin upon hospital admission. Study
participants included a convenience sample of 33 persons at risk for PUs (ie,
Braden score <18) admitted through the emergency department. Each participant had
US scans of 13 common PU body sites. All scans were documented in the radiologist
report in the electronic medical record. Creatinine phosphokinase, calcium
levels, and urine myoglobin levels also were assessed upon enrollment. Skin
failure risk factors (SFRFs), including fever, hypotension, weight loss,
coagulopathy, and acidosis/respiratory failure, also were documented. Patients
were examined for skin PUs every day for 7 days after US scan. Twenty-three (23)
patients completed the study. US scans identified pressure necrosis at 2 levels:
bone (54 positive [US+]) and subcutaneous (SC); 79 US+, respectively). US+ bone
sites resulted in 5 PUs appearing 6 to 7 days post-admission (sensitivity = 100%,
specificity 84.7%, positive predictive value 10%, and negative predictive value
100%), indicating all DTI that later became purple skin DTI were detected by the
US. US+ SC sites, located immediately under the skin, yielded 5 PUs appearing on
day 2 after admission (sensitivity 100%, specificity 74.8%, positive predictive
value 6.3%, and negative predictive value 100%). The participants with PU
occurrence in both bone and SC groups had low Braden scores (bone group mean =
13.25, SC group mean = 11.2). Study patients who were positive for PU also had >4
SFRFs. Creatinine phosphokinase, calcium, and myoglobin levels were inconsistent
and did not correlate with US+ scans. These observations warrant larger studies
to confirm findings and optimize the validity of US screening for DTI in select
populations, which may help improve protocols of care and PU admission
documentation. The preliminary results suggest inclusion of the Braden Scale
score and known PU risk factors may improve the positive predictive value of this
test.
PMID: 28355138 [Indexed for MEDLINE]
