Delmore B, Cox J, Rolnitzky L, Chu A, Stolfi A, et al.
Advances in skin & wound care. Date of publication 2015 Nov 1;volume 28(11):514-24; quiz 525-6.
1. Adv Skin Wound Care. 2015 Nov;28(11):514-24; quiz 525-6. doi:
10.1097/01.ASW.0000471876.11836.dc.
Differentiating a Pressure Ulcer from Acute Skin Failure in the Adult Critical
Care Patient.
Delmore B(1), Cox J, Rolnitzky L, Chu A, Stolfi A.
Author information:
(1)Barbara Delmore, PhD, RN, CWCN, DAPWCA, IIWCC-NYU • Program Manager • Wound &
Ostomy Service • NYU Langone Medical Center • New York Jill Cox, PhD, RN, APN-C,
CWOCN • Advanced Practice Nurse/Wound, Ostomy, Continence Nurse • Englewood
Hospital and Medical Center • New Jersey • Assistant Professor • Rutgers
University • Newark, New Jersey Linda Rolnitzky, MS • Research Scientist • NYU
Langone Medical Center • New York Andy Chu, MS, RD, CDN • Registered Dietitian •
NYU Langone Medical Center • New York Angela Stolfi, PT, DPT, Cert MDT • Director
of Physical Therapy • Rusk Rehabilitation, NYU Langone Medical Center • New York.
PURPOSE: The purpose of this learning activity is to provide information
regarding the differentiation between pressure ulcers and acute skin failure
(ASF) in critically ill patients.
TARGET AUDIENCE: This continuing education activity is intended for physicians
and nurses with an interest in skin and wound care.
OBJECTIVES: After participating in this educational activity, the participant
should be better able to:1. Describe the purpose, methodology and impact of this
research.2. Differentiate the pathophysiology of pressure ulcers and ASF.3.
Identify risk factors and diagnostic criteria for ASF.
ABSTRACT: To develop a statistical model to predict the development of acute skin
failure in patients admitted to the intensive care unit (ICU) and to validate
this model.Retrospective case-control, logistic regression modeling552 ICU
patientsIntensive care unit patients with and without pressure ulcers (PrUs) were
studied and compared on key variables sorted into the following categories: (1)
disease status, (2) physical conditions, and (3) conditions of
hospitalization.The variables, peripheral arterial disease (odds ratio [OR], 3.8;
P = .002), mechanical ventilation greater than 72 hours (OR, 3.0; P < .001),
respiratory failure (OR, 3.2; P < .001), liver failure (OR, 2.9; P = .04), and
severe sepsis/septic shock (OR, 1.9; P = .02), were found to be statistically
significant and independent predictors of acute skin failure in ICU patients.
These variables created a predictor model for acute skin failure in the ICU.Lack
of objective criteria to define acute skin failure presents a clinical conundrum
for practitioners-the acknowledgment that skin failure exists, but no clear-cut
diagnostic criteria in which to support its existence as a result of a paucity of
empirical evidence. In certain populations, such as the critically ill patient,
the phenomenon of acute skin failure may be occurring, and with the current level
of evidence, these ulcers may be incorrectly identified as PrUs. Accurately
distinguishing risk factors that lead to a PrU from factors that result in a
lesion due to acute skin failure is crucial in the quest to provide
evidence-based practice to patients.
DOI: 10.1097/01.ASW.0000471876.11836.dc
PMID: 26479695 [Indexed for MEDLINE]
