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Subepidermal Moisture and Pressure Injury in a Pediatric Population: A Prospective Observational Study
Barbara M Bates-Jensen1,2,3,4,5, Sinead Reilly1,2,3,4,5, Carol Hilliard1,2,3,4,5
1Barbara M. Bates-Jensen, PhD, RN, WOCN, FAAN, School of Nursing and David Geffen School of Medicine, University of California, Los Angeles.
Insights
Subepidermal moisture (SEM) assessment can help detect early signs of pressure injuries (PI) in children. Higher SEM readings correlated with skin redness and stage 1 PI, particularly at the heels and trochanters.
Area of Science:
- Pediatric nursing
- Dermatology
- Biomedical engineering
Background:
- Pressure injuries (PI) are a concern in pediatric patients, especially those immobilized or post-surgery.
- Early detection of PI is crucial for effective prevention and management.
- Subepidermal moisture (SEM) measurement is a non-invasive technique that may indicate tissue changes preceding visible PI.
Purpose of the Study:
- To investigate the relationship between subepidermal moisture (SEM) levels and visual skin assessments for pressure injuries (PI) in a pediatric population.
- To determine if SEM can predict early-stage PI in children.
Main Methods:
- A prospective descriptive study was conducted with 24 pediatric patients (ages 8-16) in a hospital setting.
- Subepidermal moisture was measured daily for 3 days using an SEM scanner.
- Skin visual assessments categorized discoloration (erythema, stage 1 PI, deep tissue injury) and open wounds (stage 2+ PI).
Main Results:
- SEM values for normal-appearing skin in children were lower (2.37-2.76 pF) than reported for adults.
- Significantly higher SEM values were observed for blanchable erythema and stage 1 PI, especially on heels and trochanters (P < .003).
- SEM was also found to be higher in the presence of pain, particularly at the sacrum and heels.
Conclusions:
- Subepidermal moisture measurement shows promise for detecting early signs of pressure injuries in pediatric patients.
- SEM values in children differ from those in adults, necessitating pediatric-specific reference ranges.
- Further research with larger cohorts is recommended to explore SEM and its relationship with pain for PI detection in both pediatric and adult populations.
Purpose:
To describe relationships between subepidermal moisture (SEM) and visual skin assessment of pressure injury (PI) in children.
Design:
Prospective descriptive study.
Subjects And Setting:
Twenty-four participants aged 8 to 16 years recruited from a pediatric orthopedic unit in a children's hospital in Ireland.
Methods:
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.
Results:
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).
Conclusions:
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.
