Hill Richard, Petersen Amy
Natchitoches Regional Medical Center, Natchitoches, LA.
Cass County Health System, Atlantic, IA.
Wounds. 2020 Oct;32(10):272-278. Epub 2020 Aug 31.
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.
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.
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.
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.
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.
皮肤衰竭在外观上可能与压力性损伤相似，且可能与压力性损伤同时发生，但两者病因根本不同。迄今为止，尚无经过验证的评估工具或临床指标可帮助明确区分皮肤衰竭与压力性损伤。
开发并评估皮肤衰竭临床指标量表（SFCIS），这是一种利用现成变量来更明确识别皮肤衰竭的工具。
对在急性护理医院中临终前出现急性皮肤破损的患者进行回顾性病例对照研究。数据从2017年1月1日至2019年3月1日期间美国2家医院中临终前出现急性皮肤破损的已故急性护理患者的电子病历中提取。使用国际疾病分类第十版（ICD - 10）编码，根据皮肤破损发生在压力性损伤形成的典型部位还是非典型（非压力性）部位，将患者分为两组。比较两组患者的诊断和临床数据。通过向后逐步逻辑回归进行单变量和多变量数据分析，以确定皮肤衰竭的显著预测因素；将回归系数转换为整数，以创建一种有助于可能识别皮肤衰竭的工具。
本研究纳入的52例患者中，16例在压力性损伤的典型部位出现皮肤破损，36例在非典型部位出现皮肤破损，后者被认为提示皮肤衰竭。有助于区分皮肤衰竭和压力性损伤的因素包括血清白蛋白水平低于3.5mg/dL（P = 0.07）、血流受损（P = 0.05）、存在脓毒症/多器官功能障碍综合征（P = 0.001）、使用血管升压药/正性肌力药（P < 0.001）和机械通气（P = 0.06），这些因素最终正确识别出83.7%的病例可能为皮肤衰竭。
该量表可能提供一种正确识别和诊断皮肤衰竭的方法，启动适当的干预措施，并减少医疗机构潜在的报销处罚。为验证该工具的特异性和选择性，还需要进一步测试。
