Department Neonatology, Royal Brisbane and Women's Hospital (Neonatal Unit), Herston, Queensland, Australia.
Royal Brisbane and Women's Hospital (Nursing and Midwifery Research Centre), Herston, Queensland, Australia.
Nurs Crit Care. 2024 Nov;29(6):1687-1705. doi: 10.1111/nicc.13018. Epub 2024 Feb 14.
Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment.
The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates.
This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment.
A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates.
Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations.
In the context of neonatal skin, with its unique characteristics and heightened risk for injury, clinicians must stage, categorise, and describe injury locations to provide objective information on injury severity. Given the risk for injuries across the entire body, including mucous membranes, describing the depth of the injury is essential regardless of the anatomical site. Although not originally designed for this population, a modified version of the National Pressure Injury Advisory Panel (NPIAP) classification system, which incorporates additional classifications (e.g., skin tears), remains the most applicable severity assessment system currently available. This should be supplemented by clinical images or detailed descriptive language (e.g., subtle redness) until rigorously validated severity and assessment scales, based on neonatal data, are developed-particularly for infants born at less than 27 weeks gestation. [Correction added on 25 October 2024, after first online publication: The Relevance to Clinical Practice subsection in Abstract has been added on this version.].
机械力导致的皮肤损伤在重症监护患者中很常见，尤其是新生儿。目前，损伤的识别和严重程度评估依赖于临床经验和/或使用严重程度工具。与成人相比，新生儿在不同的解剖部位发生皮肤损伤，且健康组织的层数减少（从 0.9 到 1.2 毫米），这使得人们对直接应用依赖视觉评估的成人损伤严重程度量表产生了疑问。
本次范围综述（ScR）的目的是调查用于报告新生儿医院获得性皮肤损伤的严重程度量表。
本研究采用了 2015 年乔安娜·布里格斯研究所的 ScR 方法，并根据系统评价和荟萃分析扩展的首选报告项目进行了报告。在 2001 年至 2023 年期间，对PubMed、CINAHL、COCHRANE 中央、Scopus 和纳入研究的参考文献列表进行了搜索，以查找包括新生儿人群在内的使用严重程度量表的研究。两名作者独立识别出进行全面审查、数据提取和质量评估的研究。
系统数据库搜索返回了 1163 条记录。经过对 109 项研究的全面测试审查，有 35 项研究被纳入。大多数纳入的研究是队列或行动研究，并且在美国进行。大多数研究（57%，n=20）报告了全身各部位的皮肤损伤，14 项研究（40%）仅报告了鼻区的损伤，一项研究未报告任何解剖部位的损伤。共有 9 种严重程度量表或量表组合在研究中得到了应用（n=31），4 项研究未报告量表。报告了来自国家压疮咨询小组（n=16）、欧洲压疮咨询小组（n=8）或新生儿皮肤状况评分（n=4）的各种版本的量表，以及来自当地开发的分类/量表（n=4）。量表主要为等级分组（74%，n=26）或分类评估（14%，n=5）。只有 2004 年的一项量表经过了新生儿的验证。
在新生儿皮肤的背景下，由于其独特的特征和更高的损伤风险，临床医生必须对损伤进行分期、分类和描述，以提供关于损伤严重程度的客观信息。鉴于整个身体都有受伤的风险，包括黏膜，描述损伤的深度至关重要，无论损伤的解剖部位如何。尽管最初不是为该人群设计的，但国家压疮咨询小组（NPIAP）分类系统的改良版本仍然是目前最适用的严重程度评估系统，该系统纳入了其他分类（例如，皮肤撕裂）。在开发基于新生儿数据的严格验证的严重程度和评估量表之前，应辅以临床图像或详细描述性语言（例如，轻微发红），尤其是对于 27 周妊娠以下出生的婴儿。
