In nursing home (NH) residents, sub-epidermal moisture (SEM), a measure of skin and tissue edema, detected early pressure ulcers (PrUs) prior to visual detection. We examined SEM in Veterans with spinal cord injury (SCI).
The immediate objectives were to: 1) describe the relationship between SEM and stage 1 PrUs in Veterans with SCI, 2) assess the sensitivity of various anatomic locations to SEM measures, and 3) test the relationship between SEM measurement intervals (daily, weekly, bi-weekly) and stage 1 PrUs. We also worked with several Veterans with SCI and their caregivers to develop satisfaction questions for assessing feasibility of using the SEM measure as a method of screening for early skin damage.
A prospective, single arm post-test observational design targeted non-ambulatory Veterans with SCI receiving post-acute rehabilitation or follow-up care in the hospital, outpatient clinics, NHs, and the community. Patients were enrolled from two SCI centers (Hines, Long Beach) and received daily (n=10) or weekly (n=22) concurrent visual skin assessments and SEM measured using a hand held dermal phase meter across 9 anatomic locations for 16 weeks.
SEM was lowest for normal skin (41 dermal phase units [DPU], +SD 10) and higher for erythema/Stage 1 PrUs (42 DPU, +SD 11) across all anatomic sites. Ischial and buttocks SEM differentiated between normal skin (mean SEM 41.7 to 42.5 DPU) and erythema/Stage 1 PrUs (mean SEM 44.9 to 48 DPU). SEM taken at heels was lower across all skin conditions (normal skin 30 DPU; erythema/stage 1 PrUs 33 DPU). SEM taken over scar tissue (previously healed PrUs) were lower than without scar tissue and SEM taken when generalized edema was present were higher than without generalized edema.
Although results are preliminary, use of SEM for detecting early PrU damage may translate from NH residents to persons with SCI. There are differences in SEM at the heels, and in the presence of scar tissue or generalized edema. This study provides a foundation for a larger study to implement and assess SEM use as a method for helping SCI patients prevent PrUs.
By examining the relationship between SEM and skin damage in persons with SCI, the VA may better detect early PrU damage and help prevent long hospitalizations and health complications associated with more severe PrUs.
- Guihan M, Bates-Jenson BM, Chun S, Parachuri R, Chin AS, McCreath H. Assessing the feasibility of subepidermal moisture to predict erythema and stage 1 pressure ulcers in persons with spinal cord injury: a pilot study. The journal of spinal cord medicine. 2012 Jan 1; 35(1):46-52.