Biophysical Measure To Predict Pressure Ulcers In Nursing Home Residents

描述(由申请人提供)：这项研究将使用多点纵向队列设计测试疗养院(NH)居民中具有浅或暗肤色的I期压疮(PU)的非视觉评估策略的有效性。脓液很常见，通常是可以预防的，而且成本很高；早期脓液的检测很重要，因为干预可能会防止病情恶化到更严重的程度。标准的检测方法，不可褪色红斑的视觉皮肤评估，对于肤色较浅的人来说有点可靠，但在皮肤损伤发生后会检测到变化。此外，视觉皮肤评估无法检测到深色皮肤的人的肤色变化。记录在案的非裔美国人和高加索人在I期脓疮发病率和预防干预方面的健康差异可能与检测不足有关。在我们之前的研究中，我们表明，一种手持设备评估表皮下水分(SEM)，这是一种衡量组织炎症变化引起的浮肿的指标，可以确定为I期脓液。此外，当当时没有可见的皮肤损伤但一周后皮肤上可见I期PU时，扫描电子显微镜更高(例如，水肿和炎症增加)；SEM值预测随后的I期脓液的比例为26%。在一小部分深色肤色的NH居民中也有类似的发现。我们建议测试这一创新方法在检测脓液方面的有效性，特别是针对肤色较深的居民；测试检测I期脓液和I期脓液向II+期脓肿进展的阈值SEM值。我们将招募389名NH居民，其中62人将是深肤色，根据24 NHS的最低数据集评估，他们有患PU的风险。对于同意的居民，研究人员将至少每周完成视觉皮肤评估和盲目扫描电子显微镜测量，为期4个月。NH居民的肤色将使用彩色瓷砖来评估，而不是像以前的研究那样通过种族的替代测量来评估。此外，参与者的人口统计数据、功能层面的MDS评估数据以及并存的医疗状况将从病历审查中获得。使用Braden量表预测压疮的风险评估将在基线收集。广义有序Logistic模型，适当地模拟重复观察和时间依赖的措施，将被用于评估扫描电子显微镜措施的有效性，以确定未来的皮肤损伤。扫描电子显微镜测量是减少不同肤色人群之间预防干预差异的潜在重要工具。公共卫生相关性：对公共健康的声明这个项目是评估一种新的压疮评估技术的下一步，压疮是疗养院居民常见的问题。如果这项测量可以在早期阶段识别皮肤损伤，以便及时干预，那么通过临床试验评估其使用将是强有力的证据。此外，取代依赖于肤色变化来评估皮肤损害的方法，可能会降低深色皮肤患者的皮肤损害严重程度，导致观察到的健康差距缩小，并使在预防措施最有效的时候发现损害的机会均等。

DESCRIPTION (provided by applicant): This study will test the validity of a non-visual assessment strategy for stage I pressure ulcers (PUs) among nursing home (NH) residents with light or dark skin tones using a multi-site, longitudinal cohort design. PUs are common, often preventable, and costly; detection of early-stage PUs is important because intervention may prevent decline to more severe PUs. The standard method of detection, visual skin assessment for non- blanchable erythema, is somewhat reliable for individuals with light skin tones but detects changes after skin damage has already occurred. In addition, visual skin assessment fails to detect skin color changes in persons with darkly pigmented skin. Documented health disparities between African Americans and Caucasians for incidence of stage I PUs and prevention intervention may be related to deficiencies in detection. In our prior studies, we showed that a hand-held device that assesses sub-epidermal moisture (SEM), a measure of edema from inflammatory changes in the tissues, identified stage I PUs. Further, SEM was higher (e.g., increased edema and inflammation) when there was no visible skin damage at the time but a stage I PU was visible on the skin one week later; SEM values predicted 26 percent of the subsequent stage I PUs. Findings were similar in a small sub-sample of NH residents with dark skin tones. We propose to test the validity of this innovative approach to detecting PUs, particularly focusing on residents with dark skin tones; to test threshold SEM values for detecting stage I PUs and detecting progression of stage I PUs to stage II+ PUs. We will recruit 389 NH residents, 62 of whom will have dark skin tones, who are at risk for PU based on the Minimum Data Set Assessment from 24 NHs. Visual skin assessments and blinded SEM measures will be completed by research staff at least weekly for consented residents for 4 months. Skin tone of NH residents will be assessed using color tiles rather than by proxy measures of ethnicity as in previous research. In addition, participant demographics, MDS assessment data on functional level, and comorbid medical conditions will be obtained from medical record review. Risk assessments using the Braden Scale for Predicting Pressure Sores will be collected at baseline. Generalized ordered logistic modeling, appropriately modeling the repeated observations and time-dependent measures, will be used to evaluate the effectiveness of SEM measures to identify future skin damage. Measurement of SEM represents a potentially important tool for decreasing the disparity of prevention interventions between persons with different skin tones. PUBLIC HEALTH RELEVANCE: Statement to Public Health This project is the next step in the evaluation of a new assessment technique for bedsores, a common problem for nursing home residents. If this measurement can identify skin damage at an earlier stage to allow prompt intervention, evidence will be powerful for evaluating its use through a clinical trial. In addition, replacing methods of assessing skin damage that rely on skin color changes has the potential of reducing the severity of skin damage in persons with darkly pigmented skin, leading to reduction in observed health disparities and equalizing the chance of detecting damage at a point when prevention practices can be most effective.