A 5-year retrospective study of descriptors associated with identification of stage I and suspected deep tissue pressure ulcers in persons with darkly pigmented skin.

BACKGROUND: As skin assessment is critical to pressure ulcer prevention, it is essential that practitioners performing skin assessments understand individuals with dark skin tones may represent at-risk persons. In addition, visual cues commonly associated with the identification of stage I and suspected deep tissue injury (sDTI) pressure ulcers may not be sufficient in persons with darkly pigmented skin.

OBJECTIVE: The purpose of this study was to identify common descriptors associated with stage I and sDTI pressure ulcers in persons with darkly pigmented skin, to determine whether the National Pressure Ulcer Advisory Panel (NPUAP) definitions are adequate, and to identify additional descriptors that might aid practitioners in identifying pressure ulcers in this at-risk population.

METHODS: A 5-year retrospective review of 96 subjects with 274 stage I or sDTI pressure ulcers was conducted at an acute care facility. A literature search aided in identifying descriptors associated with pressure ulcers in persons with darkly pigmented skin. Computer-queried records targeted subjects matching the descriptors of "African American," "Asian," "Hispanic," "American Indian," "Alaskan Native,"Native Hawaiian," or "Pacific Islander" descent; with a "stage I or sDTI" and a "WOCN consult" from "March-2008 through March-2013." The pressure ulcer documentation of 9 wound, ostomy, and continence nurses (WOCNs) was analyzed.

RESULTS: Stage I and sDTIs presentations were varied. However, the majority of pressure ulcers were associated with descriptors consistent with NPUAP staging guidelines. For stage I pressure ulcers, the prevailing presentation was nonblanchable erythema in 66 (75%) cases and intact skin in all 88 (100%) cases. Contrary to NPUAP guidelines, the blanching effect was commonly present. Stage I pressure ulcers also presented with normal color in 17 (11.4%) instances and were accompanied by bogginess, pain, and induration. For sDTI pressure ulcers, the prevailing color presentation was purple discoloration in 130 (70%) of the 186 cases. Intact skin was observed in 140 (75.3%) cases of the 186 cases.

CONCLUSION: Contrary to NPUAP guidelines, this study showed sDTIs can have a break in the skin, with 26 (14%) ulcers demonstrating this. This suggests the NPUAP definition may benefit from revision to improve the accuracy of sDTI identification among persons with darkly pigmented skin.