Farid KJ, Winkelman C, Rizkala A, Jones K, et al.
Ostomy/wound management. Date of publication 2012 Aug 1;volume 58(8):20-31.
1. Ostomy Wound Manage. 2012 Aug;58(8):20-31.
Using temperature of pressure-related intact discolored areas of skin to
detect deep tissue injury: an observational, retrospective, correlational study.
Farid KJ(1), Winkelman C, Rizkala A, Jones K.
Author information:
(1)Staten Island University Hospital, NY, USA. kfarid@siuh.edu
Pressure-related intact discolored areas of skin (PRIDAS) are generally described
as an area of nonblanching erythema (Stage I pressure ulcer) or deep tissue
injury (DTI), but the validity of these definitions has not been tested.
Preclinical studies and forensic observations have shown that skin temperature
may help identify nonviable tissue. To investigate the effect of temperature
difference between a PRIDAS and its adjacent intact skin and the subsequent
development of skin necrosis, an observational, retrospective, correlational
study was conducted. Data from all acute care hospital patients with an observed
PRIDAS who received a skin integrity consult, including a skin temperature
measurement of a PRIDAS site, were abstracted to ascertain if PRIDAS temperature
correlated with the development of skin necrosis after 7 to 14 days and to
examine the effect of additional patient variables on the progression or
resolution of a PRIDAS. Skin temperatures were measured using a commercial,
hand-held, infrared thermography camera, and the presence or absence of capillary
refill was documented. Among the 85 patients studied, the difference between
PRIDAS temperature and adjacent skin ranged from -3.2 ̊ C. to +3.0 ̊C. Of the 55
PRIDAS with a lower temperature at baseline than adjacent skin ("cool", average
-1.2 ̊ C), 29 progressed to necrosis, compared to one of 30 PRIDAS with a higher
temperature than adjacent skin ("warm", average + 1.2 ̊ C) (P <0.001). After
adjusting for patient age, skin color, and PRIDAS site, the cool PRIDAS were 31.8
times more likely to progress to necrosis than the warm PRIDAS. Combining the
presence/absence of capillary refill and PRIDAS temperature, 0% of 26 patients
with signs of blanching and a warm PRIDAS versus 65% of 26 patients with a
nonblanching and cool PRIDAS developed skin necrosis (P <0.001, Fisher exact test
for the difference between the two combined values). Research examining the
delayed appearance of DTI and large, multicenter, prospective validation studies
are warranted. The current National Pressure Ulcer Advisory Panel definition of a
Stage I pressure ulcer needs to be amended to reflect the strong relationship to
DTI development.
PMID: 22879313 [Indexed for MEDLINE]
