Hill R, Petersen A, et al.
Wounds : a compendium of clinical research and practice. Date of publication 2020 Oct 1;volume 32(10):272-278.
1. Wounds. 2020 Oct;32(10):272-278. Epub 2020 Aug 31.
Skin Failure Clinical Indicator Scale: Proposal of a Tool for Distinguishing Skin
Failure From a Pressure Injury.
Hill R(1), Petersen A(2).
Author information:
(1)Natchitoches Regional Medical Center, Natchitoches, LA.
(2)Cass County Health System, Atlantic, IA.
INTRODUCTION: Skin failure may be both visually similar in appearance and can
occur concomitant to a pressure injury, but it has a fundamentally different
etiology. To date, no validated assessment tools or clinical indicators are
available that can help definitively distinguish skin failure from a pressure
injury.
OBJECTIVE: The Skin Failure Clinical Indicator Scale (SFCIS), a proposed tool
that uses readily available variables to assist in more definitively identifying
skin failure, was developed and assessed.
METHODS: A retrospective case-control study was conducted among acute care
hospital patients who experienced acute skin breakdown before death. Data were
extracted from the electronic medical records of deceased acute care patients who
experienced acute skin breakdown prior to death between January 1, 2017, and
March 1, 2019, in 2 US hospitals. Using ICD-10 coding, patients were separated
into 2 groups depending on if the skin breakdown occurred at locations typical
for pressure injury formation or atypical (non-pressure) locations. Patient
diagnostic and clinical data were compared between the 2 groups. Univariate and
multivariate data analyses were performed via backward stepwise logistic
regression in order to identify significant predictors of skin failure;
regression coefficients were converted into integers in order to create a tool
that could assist in probable identification of skin failure.
RESULTS: Of the 52 patients included in this study, 16 experienced skin breakdown
at locations typical for pressure injury and 36 had skin breakdown in atypical
locations, which was assumed to be indicative of skin failure. Factors found to
help distinguish between skin failure and pressure injury included a serum
albumin level less than 3.5 mg/dL (P = .07), impaired blood flow (P = .05),
presence of sepsis/multiorgan dysfunction syndrome (P = .001),
vasopressor/inotrope use (P ⟨ .001), and mechanical ventilation (P = .06), which
ultimately correctly identified 83.7% as cases of probable skin failure.
CONCLUSIONS: This scale may provide a means to correctly recognize and diagnose
skin failure, initiate appropriate interventions, and decrease potential
reimbursement penalties to facilities. Further testing will be necessary in order
to validate the specificity and selectivity of this instrument.
PMID: 33370243
