Early Identification of Deep-Tissue Pressure Injury Using Long-Wave Infrared Thermography: A Blinded Prospective Cohort Study.
Journal
Advances in skin & wound care
ISSN: 1538-8654
Titre abrégé: Adv Skin Wound Care
Pays: United States
ID NLM: 100911021
Informations de publication
Date de publication:
01 Feb 2022
01 Feb 2022
Historique:
pubmed:
2
9
2021
medline:
27
1
2022
entrez:
1
9
2021
Statut:
ppublish
Résumé
The current clinical standard for diagnosing deep-tissue pressure injury (DTPI) is visual inspection. This method is subjective and only presents to the observer the external "picture;" deeper tissues are disguised from the observer. In contrast, long-wave infrared thermography (LWIT) can capture an image of the area of concern and detect tissue temperature relative to the level of tissue perfusion. To determine the efficacy of a handheld LWIT device and software solution as an adjunct to the current clinical standard of visual skin assessment to detect nonvisual pathophysiologic changes of DTPI. Investigators performed a blinded, prospective cohort study scanning participants' sacral area and bilateral heels with the LWIT device. Follow-up imaging took place throughout patient stays (on admission and 3, 7, 14, and 25 days thereafter). Clinicians were blinded to the LWIT images, and all participants received standard care for the prevention and treatment of wounds. Among the 70 participants enrolled in this study, there were 131 anatomical areas with intact skin at the time of admission. Four areas with initially intact skin progressed to visually identifiable DTPI. On all four of these areas, the LWIT device identified a previsual temperature anomaly before there existed a visually identifiable DTPI. The outcomes of this study suggest objective and quantitative documentation of temperature change using the LWIT device can serve as an indication of DTPI formation before visual identification is possible. Accordingly, it may allow for earlier detection of DTPI, decreasing the risk of associated complications to the patient and allowing for earlier, targeted intervention.
Sections du résumé
BACKGROUND
BACKGROUND
The current clinical standard for diagnosing deep-tissue pressure injury (DTPI) is visual inspection. This method is subjective and only presents to the observer the external "picture;" deeper tissues are disguised from the observer. In contrast, long-wave infrared thermography (LWIT) can capture an image of the area of concern and detect tissue temperature relative to the level of tissue perfusion.
OBJECTIVE
OBJECTIVE
To determine the efficacy of a handheld LWIT device and software solution as an adjunct to the current clinical standard of visual skin assessment to detect nonvisual pathophysiologic changes of DTPI.
METHODS
METHODS
Investigators performed a blinded, prospective cohort study scanning participants' sacral area and bilateral heels with the LWIT device. Follow-up imaging took place throughout patient stays (on admission and 3, 7, 14, and 25 days thereafter). Clinicians were blinded to the LWIT images, and all participants received standard care for the prevention and treatment of wounds.
RESULTS
RESULTS
Among the 70 participants enrolled in this study, there were 131 anatomical areas with intact skin at the time of admission. Four areas with initially intact skin progressed to visually identifiable DTPI. On all four of these areas, the LWIT device identified a previsual temperature anomaly before there existed a visually identifiable DTPI.
CONCLUSIONS
CONCLUSIONS
The outcomes of this study suggest objective and quantitative documentation of temperature change using the LWIT device can serve as an indication of DTPI formation before visual identification is possible. Accordingly, it may allow for earlier detection of DTPI, decreasing the risk of associated complications to the patient and allowing for earlier, targeted intervention.
Identifiants
pubmed: 34469910
doi: 10.1097/01.ASW.0000790448.22423.b0
pii: 00129334-202202000-00008
doi:
Types de publication
Journal Article
Langues
eng
Pagination
95-101Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel pressure injury staging system. J Wound Ostomy Continence Nurs 2016;43(6):585–97.
Centers for Medicare & Medicaid Services. Long-term care facility resident assessment instrument 3.0 user’s manual. 2019. Version 1.17:1. October 2019. https://downloads.cms.gov/files/mds-3.0-rai-manual-v1.17.1_october_2019.pdf . Last accessed August 17, 2021.
Stekelenburg A, Gawlitta D, Bader D, Clemens C. DTPI: how deep is our understanding? Arch Phys Med Rehabil 2008;89(7):1410–3.
Stekelenburg A. Mechanisms Associated With Deep Tissue Induced by Sustained Compression Loading [doctorate thesis]. Eindhoven, The Netherlands: Eindhoven University of Technology; 2005.
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline . Haesler E, ed. EPAUP/NPIAP/PPPIA; 2019.
Tattersall GJ. Infrared thermography: a non-invasive window into thermal physiology. Comp Biochem Physiol A Mol Integr Physiol 2016;202:78–98.
Farid KJ, Winkelman C, Rizkala A, Jones K. Using temperature of pressure-related intact discolored areas of skin to detect deep tissue injury: an observational, retrospective, correlational study. Ostomy Wound Manage 2012;58(8):20–31.
Gefen A. Deep tissue injury from a bioengineering point of view. Ostomy Wound Manage 2009;55(4):26–36.
Bhargava A, Chanmugam A, Herman C. Heat transfer model for deep tissue injury: a step towards an early thermographic diagnostic capability. Diagn Pathol 2014;9:36.
Cox J, Kaes L, Martinez M, Moles D. A prospective, observational study to assess the use of thermography to predict progression of discolored intact skin to necrosis among patients in skilled nursing facilities. Ostomy Wound Manage 2016;62(10):14–33.
Sae-Sia W, Wipke-Tevis DD, Williams DA. Elevated sacral skin temperature (T(s)): a risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients. Appl Nurs Res 2005;18(1):29–35.
Cai F, Jiang X, Hou X, et al. Application of infrared thermography in the early warning of pressure injury: a prospective observational study. J Clin Nurs 2021;30(3-4):559–71.
Andersen CA. Noninvasive assessment of lower extremity hemodynamics in individuals with diabetes mellitus. J Vasc Surg 2010;52(3 Suppl):76S–80S.
Li WW, Carter MJ, Mashiach E, Guthrie SD. Vascular assessment of wound healing: a clinical review. Int Wound J 2017;14(3):460–9.
Lucas VS, Burk RS, Creehan S, Grap MJ. Utility of high-frequency ultrasound: moving beyond the surface to detect changes in skin integrity. Plast Surg Nurs 2014;34(1):34–8.
Normahani P, Poushpas S, Alaa M, Bravis V, Aslam M, Jaffer U. Study protocol for a comparative diagnostic accuracy study of bedside tests used to detect arterial disease in diabetes: TEsting for Arterial disease in Diabetes (TrEAD) study. BMJ Open 2020;10(2):e033753.
Brownrigg JR, Hinchliffe RJ, Apelqvist J, et al. Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: a systematic review. Diabetes Metab Res Rev 2016;32 Suppl 1:119–27.
Langemo DK, Spahn JG. A reliability study using a long-wave infrared thermography device to identify relative tissue temperature variations of the body surface and underlying tissue. Adv Skin Wound Care 2017;30(3):109–19.
Koerner S, Adams D, Harper SL, Black JM, Langemo DK. Use of thermal imaging to identify deep-tissue pressure injury on admission reduces clinical and financial burdens of hospital-acquired pressure injuries. Adv Skin Wound Care 2019;32(7):312–20.
Jackson P. Pursuit of zero harm, reducing pressure injuries—clinical practice guideline implementation via quality improvement. Presented at the NPIAP Convention; Houston, Texas; February 27-28, 2020.
Black J. Using thermography to assess pressure injuries in patients with dark skin. Nursing 2018;48(9):60–1.
Judy D, Brooks B, Fennie K, Lyder C, Burton C. Improving the detection of pressure ulcers using the TMI ImageMed system. Adv Skin Wound Care 2011;24(1):18–24.
Hansen GL, Sparrow EM, Kommamuri N, Iaizzo PA. Assessing wound severity with color and infrared imaging of reactive hyperemia. Wound Repair Regen 1996;4(3):386–92.
Chanmugam A, Langemo D, Thomason K, et al. Relative temperature maximum in wound infection and inflammation as compared with a control subject using long-wave infrared thermography. Adv Skin Wound Care 2017;30(9):406–14.
Sprigle S, Linden M, McKenna D, Davis K, Riordan B. Clinical skin temperature measurement to predict incipient pressure ulcers. Adv Skin Wound Care 2001;14(3):133–7.
Edrich J, Jobe WE, Cacak RK, et al. Imaging thermograms at centimeter and millimeter wavelengths. Ann N Y Acad Sci 1980;335:456–74.