Barbara M. Bates-Jensen, PhD, RN, WOCN, FAAN, School of Nursing and David Geffen School of Medicine, University of California, Los Angeles.
Sinead Reilly, HDip (Nursing Management), Postgraduate Diploma (Orhtopaedic Nursing), HDip (Children's Nursing), RCN, RGN, Children's Health Ireland at Crumlin, Dublin, Ireland.
J Wound Ostomy Continence Nurs. 2020 Jul/Aug;47(4):329-335. doi: 10.1097/WON.0000000000000654.
To describe relationships between subepidermal moisture (SEM) and visual skin assessment of pressure injury (PI) in children.
Prospective descriptive study.
Twenty-four participants aged 8 to 16 years recruited from a pediatric orthopedic unit in a children's hospital in Ireland.
Subepidermal moisture measured with the SEM scanner (Bruin Biometrics, Los Angeles, California) ranged from 0 to 7 picoFarads [pF], and visual observation of trunk and heels occurred daily for 3 days after admission to the unit and/or after surgery. Skin was assessed for discoloration categorized as blanchable erythema, stage 1 PI, or deep tissue injury (DTI). Any open wound PI was classified as stage 2, 3, 4, or unstageable. Demographic, medical, and pain data were collected. Chi-square test, t tests, analysis of variance, and regression were used to describe data and examine relationships.
Participants were pediatric patients; 100% (n = 24) were white, 62% (n = 15) were female, 8 to 16 years of age (mean = 12.5 ± 2.5 years), and 29% (n = 7) had fractures and 71% (n = 17) surgery diagnoses. Blanchable erythema incidence was 21% (n = 5) and stage 1 PI incidence was 42% (n = 10); nearly all at heels. Deep tissue injury incidence was 4% (one sacral DTI). Stage 2 or greater PI incidence was 4% (one heel stage 2 PI). For skin that was assessed as normal in this pediatric population, SEM for trunk was 2.65 to 2.76 pF and for heels 2.37 to 2.41 pF. Subepidermal moisture for blanchable erythema and stage 1 PI was higher (range, 3.2-3.7 pF) and significant at trochanters and heels (left trochanter: P = .003; right trochanter: P = .02; right and left heels: P = .000). Nominal regression, controlling for participant and assessment day, showed SEM a predictor of erythema and stage 1 PI at heels. We also found that SEM was higher with pain (significant at sacrum and heels).
In this pediatric population, SEM values over skin assessed as normal are lower than SEM values reported for normal skin in adults, 2.37 to 2.76 pF. Subepidermal moisture was significantly higher for blanchable erythema and stage 1 PI at trochanters and heels, and with the presence of pain at sacrum and heels. We recommend that SEM should be examined for detecting PIs in pediatric populations; SEM and pain should be explored in larger pediatric and adult populations.
描述儿童皮下水分（SEM）与压力性损伤（PI）视觉皮肤评估之间的关系。
前瞻性描述性研究。
从爱尔兰一家儿童医院的儿科骨科病房招募了 24 名 8 至 16 岁的参与者。
使用 SEM 扫描仪（Bruin Biometrics，加利福尼亚州洛杉矶）测量 SEM 值范围为 0 至 7 微微法拉（pF），在入住单位后或手术后每天对躯干和脚跟进行视觉观察，持续 3 天。皮肤的变色情况进行评估，分为可褪色红斑、1 期 PI 或深部组织损伤（DTI）。任何开放性 PI 伤口均分为 2 期、3 期、4 期或不可分期。收集人口统计学、医学和疼痛数据。使用卡方检验、t 检验、方差分析和回归来描述数据并检查关系。
参与者为儿科患者；100%（n=24）为白人，62%（n=15）为女性，年龄 8 至 16 岁（平均 12.5±2.5 岁），29%（n=7）有骨折和 71%（n=17）手术诊断。可褪色红斑发生率为 21%（n=5），1 期 PI 发生率为 42%（n=10）；几乎都在脚跟。深部组织损伤发生率为 4%（1 例骶骨 DTI）。2 期或更高级别的 PI 发生率为 4%（1 例脚跟 2 期 PI）。在这个儿科人群中，被评估为正常的皮肤的 SEM 为躯干 2.65 至 2.76 pF，脚跟 2.37 至 2.41 pF。可褪色红斑和 1 期 PI 的 SEM 值较高（范围为 3.2-3.7 pF），在转子和脚跟处有显著差异（左侧转子：P=.003；右侧转子：P=.02；左右脚跟：P=.000）。名义回归，控制参与者和评估日，表明 SEM 是脚跟处红斑和 1 期 PI 的预测因子。我们还发现，SEM 值在有疼痛时会升高（在骶骨和脚跟处有显著差异）。
在这个儿科人群中，被评估为正常的皮肤的 SEM 值低于成人正常皮肤的 SEM 值，范围为 2.37 至 2.76 pF。转子和脚跟处的可褪色红斑和 1 期 PI 的 SEM 值明显更高，骶骨和脚跟处有疼痛时 SEM 值也更高。我们建议在儿科人群中检查 SEM 以检测 PI；应在更大的儿科和成人人群中探索 SEM 和疼痛。
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