Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer
Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer
In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU-compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m
2 ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter-patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.
acute care setting, biophysical parameters, pressure ulcer (PU), skin assessment, skin health
3164-3176
Abiakam, Nkemjika S.
b455695a-4135-4aaf-a1f7-fe4b8bacca04
Jayabal, Hemalatha
8f2b053c-b614-4af2-b332-8ee861ab75f6
Filingeri, Davide
42502a34-e7e6-4b49-b304-ce2ae0bf7b24
Bader, Dan L.
06079726-5aa3-49cd-ad71-402ab4cd3255
Worsley, Peter R.
6d33aee3-ef43-468d-aef6-86d190de6756
October 2023
Abiakam, Nkemjika S.
b455695a-4135-4aaf-a1f7-fe4b8bacca04
Jayabal, Hemalatha
8f2b053c-b614-4af2-b332-8ee861ab75f6
Filingeri, Davide
42502a34-e7e6-4b49-b304-ce2ae0bf7b24
Bader, Dan L.
06079726-5aa3-49cd-ad71-402ab4cd3255
Worsley, Peter R.
6d33aee3-ef43-468d-aef6-86d190de6756
Abiakam, Nkemjika S., Jayabal, Hemalatha, Filingeri, Davide, Bader, Dan L. and Worsley, Peter R.
(2023)
Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer.
International Wound Journal, 20 (8), .
(doi:10.1111/iwj.14194).
Abstract
In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU-compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m
2 ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter-patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.
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Abiakam_IWJ_Apr2023
- Accepted Manuscript
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International Wound Journal - 2023 - Abiakam - Spatial and temporal changes in biophysical skin parameters over a category
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Accepted/In Press date: 31 March 2023
e-pub ahead of print date: 14 April 2023
Published date: October 2023
Additional Information:
Funding Information:
The authors wish to thank all the patients and the health care professionals who engaged with the study for their commitment. The primary author (Nkemjika S. Abiakam) received financial support as an Early Stage Researcher from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 811965 (Project STINTS—Skin Tissue Integrity under Shear). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Funding Information:
The authors wish to thank all the patients and the health care professionals who engaged with the study for their commitment. The primary author (Nkemjika S. Abiakam) received financial support as an Early Stage Researcher from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska‐Curie grant agreement No. 811965 (Project STINTS—Skin Tissue Integrity under Shear). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Publisher Copyright:
© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.
Keywords:
acute care setting, biophysical parameters, pressure ulcer (PU), skin assessment, skin health
Identifiers
Local EPrints ID: 476927
URI: http://eprints.soton.ac.uk/id/eprint/476927
ISSN: 1742-4801
PURE UUID: d4c608a9-9b50-4ba8-b290-5e01eb8d9605
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Date deposited: 19 May 2023 16:43
Last modified: 17 Mar 2024 04:05
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Contributors
Author:
Nkemjika S. Abiakam
Author:
Hemalatha Jayabal
Author:
Dan L. Bader
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