Cox J, Kaes L, Martinez M, Moles D, et al.
Ostomy/wound management. Date of publication 2016 Oct 1;volume 62(10):14-33.
1. Ostomy Wound Manage. 2016 Oct;62(10):14-33.
A Prospective, Observational Study to Assess the Use of Thermography to Predict
Progression of Discolored Intact Skin to Necrosis Among Patients in Skilled
Nursing Facilities.
Cox J(1), Kaes L(2), Martinez M(3), Moles D(4).
Author information:
(1)Rutgers University School of Nursing, Newark, NJ; Englewood Hospital and
Medical Center, Englewood, NJ.
(2)Health Care Association of New Jersey, Hamilton, NJ.
(3)Rutgers University, School of Nursing, Newark, NJ; Emory University, Atlanta,
GA.
(4)TRANSITION HealthCare Consultants; Nursing Home Expert Opinion Services,
Monroe Township, NJ.
Skin temperature may help prospectively determine whether an area of skin
discoloration will evolve into necrosis. A prospective, observational study was
conducted in 7 skilled nursing facilities to determine if skin temperature
measured using infrared thermography could predict the progression of discolored
intact skin (blanchable erythema, Stage 1 pressure ulcer, or sus- pected deep
tissue injury [sDTI]) to necrosis and to evaluate if nurses could effectively
integrate thermography into the clinical setting. Patients residing in or
presenting to the facility between October 2014 and August 2015 with a
pressure-related area of discolored skin determined to be blanchable erythema, a
Stage 1 pressure ulcer, or sDTI and anticipated length of stay >6 days were
assessed at initial presentation of the discolored area and after 7 and 14 days
by facility nurses trained on camera operation and study protocol. Variables
included patient demographic and clinical data, data related to the discolored
area (eg, size, date of initial discovery), and temperature and appearance
differences between discolored and adjacent intact skin. Skin temperatures at
the discolored and adjacent areas were measured during the initial assessment.
All facility pressure ulcer prevention and treatment protocols derived from
evidence-based clinical practice guidelines remained in use during the study
time period. Participating nurses completed a 2-part, pencil/paper survey to
examine the feasibility of incorporating thermography for skin assessment into
practice. Data analyses were performed using descriptive statistics (frequency
analyses) and bivariate analysis (t-tests and chi-squared tests); logistic
regression was used to assess associations among patient and pressure ulcer
variables. Of the 67 patients studied, the overall mean age was 85 years (SD
10); 52 were women; 63 were Caucasian; and the top 3 diagnoses, accounting for
60% of the study sample, included neurologic (ie, cardiovascular acci-
dent/dementia [14, 21%]), cardiac-related (14, 21%), and orthopedic (13, 19%)
conditions. Twenty-eight (28) participants were long-term care patients, and 39
were admitted as short-stay patients. The most frequently reported location of
discolored intact skin on presentation was the heel (27, 40%). The mean
temperature at the site of the discolored skin was 33.6 ̊ C (SD 3) and at the
adjacent skin was 33.5 ̊ C (SD 2.5). The mean size of the areas of discoloration
was 11 cm2 (SD 21). Capillary refill of the discolored area was absent on
initial presentation in 49 patients (72%), and demarcation of the discolored
borders was evident for 45 (66%). Of the 67 patients, 30 (45%) experienced
complete resolution of the discolored area. At day 7, 8 (16%) of the remaining
50 patients in the sample exhibited skin necrosis and at day 14, a total of 12
patients of the remaining 37 (32%) exhibited skin necrosis. At day 7, skin
necrosis was significantly associated with admission to a subacute unit (P =
0.01) and at day 14 to negative capillary refill at initial presentation (P =
0.02). Regardless of skin temperature, negative capillary refill at presentation
was significantly associated with skin necrosis at day 7 (P = 0.04). A
dichotomous variable was constructed to examine patients with cooler
temperatures at the site as compared to their adjacent skin and persons with
warmer skin temperatures at the center of the discolored skin for the presence
of skin necrosis at both day 7 and day 14. In multivariate analysis, patients
with cooler rather than warmer skin temperatures at the center of the discolored
area as compared to the adjacent skin were more likely to develop necrosis by
day 7 (OR 18.8; P = 0.05; CI: 104-342.44). Participating nurses were uncertain
about the feasibility of integrating thermography into practice. Larger
prospective studies with more heterogeneous samples are needed to determine the
validity of skin temperature measurement as a predictor of skin necrosis and the
utility of implementing thermography into clinical practice.
PMID: 27768578 [Indexed for MEDLINE]
