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Assessing Clinical Deterioration in Children With Dark-Coloured Skin: A Scoping Review
Chelsea Kelly1,2, Gavin D Leslie1,3, Pamela Laird1,2,4
1School of Nursing, Curtin University, Bentley, Western Australia, Australia.
Insights
Assessing clinical deterioration in children with dark skin is crucial but poorly defined. More high-quality research is needed to accurately identify signs of illness in this population.
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.
Background:
Signs of clinical deterioration may appear differently in children with dark-coloured skin. How to assess children in this cohort is currently poorly defined.
Aim:
To explore available information on the assessment of clinical deterioration in children with dark-coloured skin and identify research deficits.
Methods:
A scoping review following Arksey and O'Malley and PRISMA-ScR frameworks. Five online databases, grey literature and reference lists of eligible documents were searched. Source titles, abstracts and full texts were screened. Included documents were assessed for level of evidence according to the Joanna Briggs Institute. Data were charted on a pre-defined data collection tool and analysed through descriptive and content analysis.
Results:
Out of 2382 documents screened, 37 were included. Document types included 16 quantitative studies, 14 opinion papers, five reviews and two reports. Most sources (21) were low-level evidence. Sixty-six unique terms were used to describe dark-coloured skin. Eighteen documents reported use of a skin classification system, including race/ethnicity, established colour scales, cosmetic references and observer opinion. Twelve focused on newborn hyperbilirubinaemia. Considerations for assessing jaundice, pallor, cyanosis, pulse oximetry, petechiae and signs of shock were reported. Techniques to improve assessment included optimising the environment, identifying baseline skin colour, and involving families and patients in assessment. No documents reported on assessment of mottling or capillary refill time for children with dark-coloured skin.
Linking Evidence To Action:
Assessment of clinical deterioration for children with dark-coloured skin is highly relevant to health professional practice. There is an overall deficit in high-quality research. Specific information gaps in assessment are considerations for mottling, capillary refill time, APGAR scoring, and clinical implications of device overestimation of bilirubin and oxygen saturations in children with dark-coloured skin. Health professionals are encouraged to use devices cautiously. Greater accuracy and objectivity are necessary to fill these gaps and support effective detection of signs of clinical deterioration.
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