Assessing Clinical Deterioration in Children With Dark-Coloured Skin: A Scoping Review

Area of Science:

• Pediatric Healthcare
• Clinical Assessment
• Health Equity

Background:

• Clinical deterioration signs may differ in children with dark-coloured skin.
• Current methods for assessing these children are inadequately defined.

Purpose of the Study:

• To review existing literature on assessing clinical deterioration in children with dark-coloured skin.
• To identify gaps in research concerning this vulnerable population.

Main Methods:

• A comprehensive scoping review was conducted using PRISMA-ScR and Arksey and O'Malley frameworks.
• Searches included five databases and grey literature, with rigorous screening and data analysis.
• Included documents were assessed for evidence level using the Joanna Briggs Institute guidelines.

Main Results:

• Out of 2382 documents, 37 were included, predominantly low-level evidence (21 sources).
• Sixty-six terms described dark-coloured skin; 18 used classification systems.
• Specific assessment considerations for jaundice, pallor, cyanosis, pulse oximetry, petechiae, and shock were noted, but mottling and capillary refill time were absent.

Conclusions:

• High-quality research on assessing clinical deterioration in children with dark skin is significantly lacking.
• Key information gaps include mottling, capillary refill time, APGAR scoring, and device accuracy for bilirubin and oxygen saturation.
• Health professionals should use devices cautiously, advocating for improved accuracy and objectivity to detect deterioration effectively.