Subepidermal moisture predicts erythema and stage 1 pressure ulcers in nursing home residents: a pilot study

Abstract

Objectives: To examine the relationship between a measure of subepidermal moisture (SEM) and visual skin assessment (VSA) of erythema and Stage 1 pressure ulcers (PUs) performed a week later in nursing home (NH) residents.

Design: Descriptive, cohort study.

Setting: Two NHs.

Participants: Thirty-five residents.

Methods: Concurrent VSAs and SEM readings were obtained at the sacrum, right and left trochanters, buttocks, and ischial tuberosities weekly for 52 weeks. SEM was measured using a handheld dermal phase meter, with higher readings indicating greater SEM (range 0-999 dermal phase units [DPUs]). VSA was rated as normal, erythema/Stage 1 PU, or Stage 2+PU. SEM was modeled as a predictor of VSA of erythema and PUs 1 week later (controlling for clustering), with concurrent moisture, Braden Scale PU risk status, anatomic site, and ethnicity as covariates.

Results: Participants had a mean age of 84.7, 83% were female, and 80% were non-Hispanic white. SEM measures were lowest for normal skin (97+/-122 DPU), higher for erythema/Stage 1 PUs (192+/-188 DPU), and highest for Stage 2+PUs (569+/-320 DPU) across all sites (all P<.001). SEM was responsive to changes in VSA, and higher SEM predicted greater likelihood of erythema/Stage 1 PU the next week (odds ratio=1.26 for every 100-DPU increase in SEM, P=.04).

Conclusion: SEM measures are associated with concurrent erythema and PUs and future (1 week later) development of erythema/Stage 1 PUs. SEM may assist in predicting early PU damage, allowing for earlier intervention to prevent skin damage.

Figures

Figure 1

Flow of participants through the study. Of the 35 (40% consent rate) consented subjects, 28 completed the 52 weeks of the study, two withdrew, and five died.

Figure 2

Cumulative distribution of subepidermal moisture (SEM) is provided for each of three levels of visual skin assessment (VSA): no skin damage, mild skin damage (erythema or Stage 1 pressure ulcer), and more-severe skin damage (Stage 2+pressure ulcer). When evaluated at the 50% level for cumulative frequency according to VSA, SEM values are lowest when no skin damage is observed, followed by higher values for mild damage and highest values for severe damage.