School of Human & Health Sciences, University of Huddersfield, UK.
Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK.
J Wound Care. 2022 Apr 2;31(4):294-303. doi: 10.12968/jowc.2022.31.4.294.
This study assesses anonymous patient-level data on the use of sub-epidermal moisture (SEM) assessment technology as a tool in the prevention of pressure ulceration in at-risk hospital patients.
The relationship between technology-generated prompts for clinical action (patient turning, application of pressure redistributing equipment, heel protection or cream) and consequent clinical action was evaluated using data cross-tabulations (using data aggregated over multiple anatomical sites); in a multilevel model with patients clustered within wards, clustered in turn within hospitals, and controlling for additional patient- and institution-level factors; and using receiver operating characteristic (ROC) analyses of anatomy-specific data. The ability of the SEM assessment technology to detect deep and early-stage pressure ulcers/injuries on specific anatomical areas of a patient's body on admission, earlier than visual and tactile skin tissue assessments (STA), was assessed.
A total of 15,574 patient assessments ('cases') were reported on 1995 patients. Most incidences of nurse action were in response to a prompt from SEM assessments (4944/5494; 90.0%). An SEM delta (Δ)≥0.6 resulted in nurse action in 4944/13,071 cases (37.8%). The multilevel model revealed strong evidence that SEM Δ prompts were significantly associated with nurse action (p<0.001; adjusted odds ratio: 1.99).
In this study, SEM assessment technology effectively prompted nurse action moreso than skin reddening diagnosed via trained clinician judgement and STAs. While baseline responses of nurses' actions remained low, with or without SEM Δ prompts, findings verified the 'clinical utility' of SEM assessment technology as an objective prompt for early clinical action over and above existing mechanisms.
本研究评估了匿名患者水平数据，以评估表皮下水分（SEM）评估技术作为预防高危医院患者压疮的工具的使用情况。
使用数据交叉表（使用多个解剖部位汇总的数据）；在一个包含病房内患者、医院内患者聚类的多水平模型中，并控制其他患者和机构水平因素；以及使用解剖部位特异性数据的接收器操作特征（ROC）分析，评估技术生成的临床操作提示（患者翻身、应用压力再分布设备、脚跟保护或乳膏）与随后的临床操作之间的关系。评估 SEM 评估技术在患者入院时检测特定解剖区域的深部和早期压疮/损伤的能力，比视觉和触觉皮肤组织评估（STA）更早。
共报告了 1995 名患者的 15574 次患者评估（“病例”）。大多数护士采取行动是为了响应 SEM 评估的提示（4944/5494；90.0%）。SEMΔ≥0.6 导致护士采取行动的情况有 4944/13071 例（37.8%）。多水平模型显示，SEMΔ提示与护士行动之间存在很强的关联（p<0.001；调整后的优势比：1.99）。
在这项研究中，SEM 评估技术比经过训练的临床医生判断和 STA 诊断的皮肤变红更有效地提示护士采取行动。虽然基线时护士行动的反应仍然较低，但有无 SEMΔ提示，结果均验证了 SEM 评估技术作为一种客观的早期临床行动提示的“临床实用性”，超过了现有机制。
