Incidence of Skin Tears and Risk Factors: A Systematic Literature Review

The Prevalence of Skin Tears in an Acute Care Hospital: A Quality Improvement Project

PURPOSE

The purpose of this quality improvement project was to determine the prevalence of skin tears (STs) within an acute care hospital.

PARTICIPANTS AND SETTING

The setting was a 676-bed Midwestern urban teaching hospital with Magnet designation in the United States. All adult, children, and neonatal patients were assessed during the data collection period with the exclusion of the mother/baby unit and patients who were unsafe to move, actively dying, off the unit during the survey assessment, or those who declined participation.

APPROACH

ST prevalence data were collected concurrently with the quarterly Pressure Injury Prevalence Survey over a period of 12-months (beginning the third quarter of 2017 through the second quarter of 2018) by the Pressure Injury Prevalence Survey Skin Care Champions using the revised Payne-Martin classification system for STs. A data collection form developed by the Wound, Ostomy, and Continence nurse was also completed for the patients with ST(s).

OUTCOMES

The prevalence of STs was 2.92% (46/1576 patients). Twenty-one patients were women and 25 were men, with a mean age of 69.90 years (age range: 8 days-96 years). The majority of STs were found on the extremities (60 STs, 86.96%) and hospital-acquired (30 patients, 65.22%). Thirty STs (43.48%) were category III according to the revised Payne-Martin classification system for STs with major risk factors identified as frail skin (n = 34), advanced age (n = 30), and impaired mobility (n = 24).

IMPLICATIONS FOR PRACTICE

STs are a common finding in the acute care setting spanning all age groups and are frequently overlooked by health care providers. This project provides a strategy to determine ST prevalence in a health care setting. Additional studies should focus on risk factor assessment and prevention strategies as these may decrease the incidence of this painful wound.

Skin tears in older patients in intensive care units: A multicentre point prevalence study

BACKGROUND

With the ageing of the global population, it is predicted that the population of older adult patients in hospitals and intensive care units (ICUs) will increase. Because of health conditions, care practices and ageing-related skin changes, older adult ICU patients are prone to skin integrity problems, including skin tears (STs).

AIM

To determine the prevalence of STs and associated factors in older patients hospitalized in ICUs.

STUDY DESIGN

The study is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. Data were collected simultaneously in each centre on the same day. The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and 200 patients who were 65 years of age or older, were hospitalized in ICUs and agreed to participate in the research were included. The researchers formed an "ST chart" to record patient demographic characteristics, clinical variables and skin assessment.

RESULTS

STs were detected in 14.5% of patients in ICUs, with 72.5% of them having stage 1 ST. A significant relationship was found between individuals' average body mass index (BMI) (p = .043), age (p = .014), length of stay in the ICU (p = .004) and having ST. There was also a statistically significant relationship between skin temperature (p = .002), skin turgor (p = .001) and ST. More STs were observed in patients with cold skin and low turgor. The prevalence of ST was higher in individuals with a history of ST. Additionally, there was a statistically significant relationship between consciousness (p = .014), incontinence (p = .006), the Braden score (p = .004), the Itaki fall risk score (p = .006) and ST.

CONCLUSIONS

In this multicentre point prevalence study, the prevalence of ST in older patients in ICUs was 14.5%, and many factors associated with ST have been identified.

RELEVANCE TO CLINICAL PRACTICE

Given the insufficient information and attention to STs in older adults, the study emphasizes the importance of addressing STs. The impact of STs includes increased treatment costs, length of stay and risk of complications. Therefore, understanding the global extent of STs in ICUs and developing effective interventions for prevention and management are crucial.

Prevalence and incidence of skin tear in older adults：A systematic review and meta-analysis

BACKGROUND

Skin tear (ST) is a public health problem in older adults; they substantially increase the risk of complications and cause serious adverse consequences and health care burden.

AIM

To estimate the pooled prevalence and incidence of ST among older adults.

METHODS

Ten databases were systematically searched from their inception to July 27, 2023. Two researchers performed a systematic review independently according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All inconsistencies were resolved by a principal researcher. The pooled prevalence and incidence of ST were estimated in R 4.3.1 program.

RESULTS

Thirteen studies were included in this review. The pooled prevalence of ST was 6.0 % (95 % confidence interval (CI): 3.0%-11.0 %, I2 = 98 %), and the pooled incidence was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 94 %). The prevalence of ST was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 95 %) in long-term care facilities, 5.0 % (95 % CI: 3.0%-9.0 %, I2 = 86 %) in Europe, and 7.0 % (95 % CI: 1.0%-16.0 %, I2 = 82 %) in the Skin Tear Audit Research classification system (STAR). It has stabilized at 6.0 % since 2021. The incidence of ST was 15.0 % (95 % CI: 11.0%-20.0 %, I2 = 66 %) in long-term care facilities in Japan and 4.0 % (95 % CI: 2.0%-6.0 %) in Canada.

CONCLUSIONS

Older adults are at a high risk for ST. Our findings emphasize the importance of epidemiologic studies and further exploring assessment tools for ST. Healthcare professionals should pay attention to ST, identify high-risk individuals and associated factors, and implement targeted prevention strategies for older adults.

Assessment, prevention and management of skin tears in older people

Skin tears are common injuries that result from mechanical forces. Older people with fragile skin are at greater risk of this type of wound. They are usually categorised as acute wounds that typically heal in 7-21 days but the healing process can be disrupted, leading to chronic, non-healing wounds. They have the potential to compromise quality of life and disrupt daily activities, so it is important to identify risk factors and implement prevention strategies for those at risk. An interdisciplinary approach has a pivotal role in promptly and precisely identifying skin tears, and the use of evidence-based interventions for efficient skin damage management can enhance the recovery process. This article adopts a case study approach to explore the prevention, evaluation and treatment of skin tears, using the case of an individual living with a skin tear in a community setting.

Mixed-Methods Study of End-of-Life Experiences of Patients With Hematologic Malignancies in Social Hospice Residential Home Care Settings

PURPOSE

Hospice is underutilized by patients with hematologic malignancies (HM), and when patients are referred, they are typically more ill, hospitalized, and with shorter length of stay (LOS) than patients with solid tumors (ST), limiting research about home hospice care experiences of patients with HM. In this mixed-methods study, we examined the hospice experiences of patients with HM who died at residential care homes (RCHs), home-based settings in which volunteer caregivers and hospice staff provide end-of-life (EOL) care under the social hospice model.

METHODS

We queried a registry of 535 hospice patients who died at RCHs between 2005 and 2020 that included quantitative medication administration data as well as qualitative data from hospice intake forms and written volunteer caregiver narratives. Qualitative data were analyzed by collective case study methodology. Quantitative comparisons of LOS and liquid morphine use were performed with matched patients with ST.

RESULTS

The registry yielded 29 patients with HM, of whom qualitative data were available for 18 patients. Patients with HM exhibited common EOL symptoms (pain, dyspnea, and agitation). Instances of bleeding were low (22%), and notable HM-specific care concerns were described regarding bone fractures, skin integrity, and delirium. Most (78%) experienced good symptom management and peaceful or comfortable deaths. In only one case were symptoms described as severe and poorly managed. Patients with HM had comparable LOS on hospice and at the RCHs to patients with ST, with no group differences in liquid morphine use.

CONCLUSION

In this registry cohort, most patients with HM achieved good symptom management in home care settings with volunteer caregivers and hospice support. Caregivers may require additional counseling and palliative medications for HM-specific EOL symptoms.

Region-Based Semi-Two-Stream Convolutional Neural Networks for Pressure Ulcer Recognition

Pressure ulcers are a common, painful, costly, and often preventable complication associated with prolonged immobility in bedridden patients. It is a significant health problem worldwide because it is frequently seen in inpatients and has high treatment costs. For the treatment to be effective and to ensure an international standardization for all patients, it is essential that the diagnosis of pressure ulcers is made in the early stages and correctly. Since invasive methods of obtaining information can be painful for patients, different methods are used to make a correct diagnosis. Image-based diagnosis method is one of them. By using images obtained from patients, it will be possible to obtain successful results by keeping patients away from such painful situations. At this stage, disposable wound rulers are used in clinical practice to measure the length, width, and depth of patients' wounds. The information obtained is then entered into tools such as the Braden Scale, the Norton Scale, and the Waterlow Scale to provide a formal assessment of risk for pressure ulcers. This paper presents a novel benchmark dataset containing pressure ulcer images and a semi-two-stream approach that uses the original images and the cropped wound areas together for diagnosing the stage of pressure ulcers. Various state-of-the-art convolutional neural network (CNN) architectures are evaluated on this dataset. Our experimental results (test accuracy of 93%, the precision of 93%, the recall of 92%, and the F1-score of 93%) show that the proposed semi-two-stream method improves recognition results compared to the base CNN architectures.

Preventing and recognising skin tears using a standardised approach

Skin tears, defined as traumatic wounds caused by mechanical forces, can be debilitating for individuals, causing pain and reduced mobility. Although skin tears can develop throughout the lifespan, older age can make the skin increasingly susceptible to this type of injury. Studies have found wide variation in the incidence and prevalence of skin tears, in part because of suboptimal recognition and reporting practices among healthcare professionals. Effective prevention of skin tears requires a standardised approach to risk assessment, prevention, recognition and classification, such as that offered by the International Skin Tear Advisory Panel (ISTAP) best practice recommendations. This article examines the literature on the incidence, prevalence, prevention and recognition of skin tears, and outlines some of the ISTAP best practice recommendations on risk assessment, prevention and recognition. The authors also consider the need for patient and healthcare professional education to optimise the prevention of skin tears.

A retrospective study of inpatients diagnosed with degloving skin and soft tissue injuries

The overall picture of degloving skin and soft tissue injuries (DSTI) remains a blank space in China. Therefore, a retrospective study was designed to summarize the current situation of this injury. Patients diagnosed with DSTI hospitalized between 2013 and 2018 were identified from the Hospital Quality Monitoring System (HQMS) database, of whom demographics, injury characteristics, hospitalization and cost information were analyzed. A total of 62,709 patients were enrolled in this study. Male sex predominated, with a mean age of 43.01 ± 19.70 years. Peasants seemed to be the most vulnerable. East China and Hubei province had the most patients. The most and least frequently injured anatomic site were lower extremity and torso, respectively. Traffic-related accidents and summer accounted for the highest proportion in terms of injury mechanism and season. The operation rate of DSTI roughly showed a growing trend, and the average length of stay was 22.02 ± 29.73 days. At discharge, 0.93% of DSTI patients ended up in death. Medicine accounted mostly for hospitalization cost, while the proportion decreased year by year. More than half DSTI patients paid at their own charge. This study made a relatively detailed description of DSTI patients nationwide, and might provide enlightenments for better prevention and treatment.

Impact of hydrocolloid dressings in the prevention of pressure ulcers in high-risk patients: a randomized controlled trial (PENFUP)

It is uncertain whether hydrocolloid dressings, a more costly intervention than offering standard care with petrolatum, is superior to prevent pressure ulcers among hospitalized high-risk adults. Randomized, parallel-group, open-label, superiority trial with an active control group, blinded for investigators, event validators, and analysts (December 1, 2015 to December 12, 2017). Eligible patients were ≥ 18 years of age with intact skin judged as high-risk for skin ulcers (Braden scale), admitted to surgical or medical wards of two tertiary-level hospitals. Participants were randomized (1:1) to protection with hydrocolloid dressings or petrolatum. The primary outcome was the first occurrence of pressure ulcers (with post-injury photographs adjudicated by three judges) under intention-to-treat analysis. Based on prior cost analysis, and the available resources (assumed incidence of 6 ulcers/1000 patient-days in controls), inclusion of up to 1500 participants allowed to surpass a one-sided superiority threshold > 5% based on a target efficacy > 40% for dressings. We planned an economic analysis using a decision tree model based on the effectiveness of the study results from a perspective of the third payer of health care. After inclusion of 689 patients (69 events), the trial was stopped for futility after a planned interim analysis (conditional power < 0.1 for all scenarios if the trial was completed). Pressure ulcers had occurred in 34 (10.2%) patients in the intervention group [9.6 per 1000 patient-days] and 35 (9.9%) participants in the control group [7.9 per 1000 patient-days], HR = 1.07 [95% CI 0.67 to 1.71]. The estimated incremental cost for dressings (a dominated strategy) was USD 52.11 per patient. Using hydrocolloid dressings was found similar to petrolatum for preventing pressure ulcers among hospitalized high-risk patients. As it conveys additional costs, and in this study was unlikely to demonstrate enough superiority, this strategy did not overcome conventional skin care.Trial registration: ClinicalTrials.gov identifier (NCT number): NCT02565745 registered on December 1, 2015.

Skin properties associated with skin tears in older adults: A case-control study

BACKGROUND

The world population is growing rapidly and skin problems such as skin tears (STs) are more common in aging skin due to changes in the epidermis and dermis. Identification of ageing related skin properties, which are risk factors for STs, is essential for the development of ST prevention protocols.

OBJECTIVE

The aim of this study was to reveal the skin properties related to epidermal function and dermal associated with STs.

MATERIAL AND METHODS

A prospective case-control study was conducted with a sample of 36 older adults, 18 participants with ST and 18 participants without ST, in two elderly care centers. Tewameter TM 210 was used to measure transepidermal water loss, the Sebumeter SM810 was used to measure sebum, and Cutometer Dual MPA 580 was used to measure skin viscoelasticity (R0-R9). The differences of skin properties between groups were analyzed using the independent t-test and Mann-Whitney U test.

RESULTS

The case group had a mean age of 77,17 ± 9,7 and the control group had a mean age of 75,33 ± 6,8. It was determined that there were more ecchymosis (p < 0.000), hematoma (p = 0.008), and ST history (p = 0.001) in the case group. Older adults in the case group were more frail than the control group (p = 0.044). Regarding the score of the skin properties, the case group showed that the TEWL levels of the older adults in the case group were lower (p = 0.031) compared to the control groups. There was a significant difference between the groups and R0, R2, R5, and R7. While R0 was higher in the case group, R2, R5, and R7 were lower than the control group.

CONCLUSION

Older adults with ST showed differences in skin properties compared to those without ST, especially transepidermal water loss, and viscoelasticity (R0, R2, R5, R7). The results of this study suggest that some changes in skin properties may be a risk factor for STs.

Skin assessments and interventions for maintaining skin integrity in nursing practice: An umbrella review

BACKGROUND

Daily skin care routines are fundamental aspects of clinical nursing practice. Providing skin care, including skin cleansing and application of leave-on products have substantial impact on the prevention and treatment of a number of skin conditions. There are hundreds of individual studies about skin risks, classifications, skin conditions, prevention and treatment.

OBJECTIVE

To summarise the overall evidence regarding 1) risk factors associated with xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 2) the performance of diagnostic tests and/or classifications addressing the severity and/or signs and symptoms of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 3) the effects of skin cleansing/care interventions for the maintenance and promotion of skin integrity in all age groups, 4) effects of skin cleansing/care interventions for the prevention of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears in all age groups.

DESIGN

Umbrella review.

DATA SOURCES

A systematic search in MEDLINE and Embase (via OvidSP), Cochrane and Epistemonikos was conducted. Reference lists and experts were consulted for potentially missed reviews.

REVIEW METHODS

Two reviewers screened titles/abstracts and full-texts independently. After rating the risk of bias only low to high overall confidence (AMSTAR 2) and low risk of bias (ROBIS) reviews were included.

RESULTS

Twelve systematic reviews were included. Due to substantial heterogeneity regarding study designs, methods, and outcomes all authors presented findings in a narrative synthesis. The validity and reliability of the International Skin Tear Advisory Panel classification is supported by moderate quality evidence, and the reliability and criterion validity for Skin Tear Audit Research were rated insufficient. Overall, review results indicate that structured skin care programs are preferable to unstructured skin care with classic soap and water for maintaining skin integrity in general, preventing skin tears, and to prevent and treat xerosis cutis and incontinence-associated dermatitis. All reviews focusing on leave-on products for the prevention and treatment of incontinence-associated dermatitis and diaper dermatitis indicate the effectiveness of barrier films or lipophilic leave-on products in adults, elderly people and paediatric care, but could not establish the superiority of any product.

CONCLUSIONS

The majority of systematic reviews in the field of skin care is at high risk of bias and should not be used for evidence-based practice. Overall, evidence indicates, that structured skin care programs containing low-irritating cleansers and application of leave-on products are beneficial to maintain skin integrity and prevent skin damage across a wide range of different skin conditions across the life span.

The Science of Skin: Measuring Damage and Assessing Risk

Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.

Prevalence and associations of xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo in aged nursing home residents: A representative prevalence study

BACKGROUND

The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time.

OBJECTIVES

Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents.

DESIGN

Analysis of baseline data of a cluster-RCT in long-term residential settings.

SETTING

The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany.

PARTICIPANTS

Care dependent nursing home residents being 65+ years.

METHODS

A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted.

RESULTS

Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo.

CONCLUSIONS

The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways.

REGISTRATION

This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).

Risk of skin tears associated with nursing interventions: A systematic review

BACKGROUND

Skin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions.

OBJECTIVES

To examine which nursing interventions increase the risk of skin tears.

DESIGN

Systematic review.

DATA SOURCES

The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022.

PUBLICATION YEARS

Publications included were from 2012 to 2022.

RESULTS

Seventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears.

CONCLUSION

Nursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.

Retrospective evaluation of elevator-related injuries in dogs (2015-2020): 13 cases

OBJECTIVE

To describe elevator-related injuries in dogs.

DESIGN

Retrospective study, August 2015 to October 2020.

SETTING

Four urban referral and emergency veterinary facilities.

ANIMALS

Thirteen client-owned dogs presenting with injuries sustained while using an elevator.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Thirteen dogs were treated for elevator-related injuries. The mean age of this population was 4.9 ± 4.1 years. Median body weight was 4.3 kg (range = 1.5-32 kg). Dogs in this study were significantly smaller than dogs presenting for all types of trauma during the same study period found in the Veterinary Committee on Trauma registry (VetCOT) (median = 14.5 kg, range = 0.1-141; P = 0.038). There was no difference in age between this study population and dogs presenting for trauma in the VetCOT registry (median = 4.2 years, range = 0.1-26.4, P = 0.7358). Nine dogs sustained a crush injury (69%), and 7 of these dogs received surgical intervention. Four dogs experienced leash entrapment in the elevator doors (31%), and none required surgical intervention. Two of these 4 dogs required inpatient hospital care. No deaths occurred in either group.

CONCLUSIONS

Injuries that can be sustained by dogs in an elevator include crush injuries from doors closing on limbs or tails and injury due to leash entrapment in an elevator door. Many elevator-related injuries required surgical intervention, and recovery was often protracted. All dogs survived to hospital discharge in the present study, and none of the injuries in these dogs had serious long-term consequences.

Skin tears in older adult residents of long-term care facilities: prevalence and associated factors

OBJECTIVE

To determine the prevalence of skin tears, and demographic and clinical factors associated with their presence in older adult residents of long-term care facilities.

METHOD

This observational, quantitative, cross-sectional, epidemiological study was conducted with older adult residents of three long-term care facilities in São Paulo, Brazil. For data collection, four instruments were used: a questionnaire assessing sociodemographic and clinical characteristics of the residents; and the Brazilian-Portuguese versions of the Mini-Mental State Examination, Skin Tear Audit Research (STAR) Skin Tear Classification System, and the Katz Index of Independence in Activities of Daily Living.

RESULTS

A total of 69 residents took part in the study. The prevalence of skin tears was 11.6%. Skin tears were significantly associated with the presence of haematoma (odds ratio, OR=9.159; p=0.017) and actinic purpura (OR=6.265; p=0.033), which increased the odds of skin tear development nine-fold and six-fold, respectively.

CONCLUSION

The findings agree with the international literature. Considering that this was the first epidemiological study on skin tears carried out in long-term care facilities for older adults in Brazil, its contribution lies in the systematisation of data collection and making data available on a field that has not yet been studied in this country.

What is the impact of skincare bundles on the development of skin tears in older adults? A systematic review

AIM

This review explores the impact of skincare bundles on the development of skin tears in older adults (≥65 years).

METHOD

A systematic search of publications using MEDLINE, CINAHL and Cochrane databases was conducted in July 2020. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. Data were extracted using a pre-designed extraction tool, and a narrative analysis was undertaken.

RESULTS

Following the search, 71 records were returned, with seven satisfying the inclusion criteria. The studies were conducted between 2003 and 2015, and 57% (n = 4) of these employed a pre-post study design. The mean sample size was 155 participants (SD = ±117.6). All the included studies (100%, n = 8) identified that there was a direct relationship between the use of skincare bundles and the reduction in the incidence of skin tears in the elderly. The EBL scores varied between 65% and 91%. In total, 85.7% (n = 6) of the studies scored ≥75%, reflecting validity.

CONCLUSION

This systematic review highlights the connection between skincare bundles and the reduction of the number of skin tears in the older population (≥65 years). Further research with larger sample sizes and longer study duration to validate these findings, which will provide a comprehensive insight into the prevention of the incidence of skin tears. Further studies are justified given that skin tear bundles can reduce the rate of injuries that are easily acquired by the elderly due to the nature of their frail skin, they also can help prevent skin tears from turning into chronic wounds and can decrease hospital admissions associated with hospital-acquired infections.

Palliative Wound Care: Case Studies

Patients with advanced illness may present to palliative care or hospice with unmanaged symptoms that may be exacerbated by the presence of a wound. The wound can be a constant reminder to the patient and caregiver of the underlying illness. Distressing symptoms such as wound pain, odor, bleeding, and/or excessive exudate may impede the patients' ability to spend quality time with loved ones when they need them the most. Although patients may present with wounds of varying etiologies, the most common wounds seen in this patient population are pressure-related injuries. However, there is a shortage of both wound and palliative specialized clinicians. Telehealth and the use of other technology can be a way to address this shortage. This will grant access to a broader number of patients to ensure appropriate wound care plans are in place to meet the goals of care. Although wound healing may not always be possible in this patient population, having access to specialized wound and palliative experts can improve the quality of life for patients and their caregivers.

Chronic wounds in persons living with dementia: An integrative review

BACKGROUND

Persons living with dementia (PLWD) are at risk for chronic wounds; however, they are rarely included in research.

OBJECTIVES

To inform practice and research directions, the aim of this integrative review was to identify and synthesise previous knowledge about the characteristics of chronic wounds in PLWD, in terms of chronic wound types, prevalence, setting and interventions.

DESIGN

A literature search was conducted for publications in English using PubMed, Web of Science and CINAHL. The minimum information required for inclusion was how many PLWD enrolled in the study had wounds.

METHODS

This integrative review followed the Whittemore and Knafl methodology. Data extraction and synthesis were guided by a directed content analysis, with a coding structure based on an initial review of the literature.

RESULTS

Thirty-six articles met the inclusion criteria. The majority were missing characteristics of PLWD including severity of dementia and race/ethnicity/nationality, and none mentioned skin tone. Most focused on pressure injuries in the nursing home and acute care setting. Few included information on interventions. Only one discussed challenges of wound care for a PLWD exhibiting aggression.

CONCLUSION

There is a gap in the literature regarding PLWD and chronic wounds other than pressure injuries that are common in older adults (e.g. diabetic foot ulcers, venous leg ulcers). Research is warranted among those PLWD who live alone and those who receive wound care from family caregivers to understand experiences. Knowledge can inform the development of future novel interventions for wound healing. Future research is needed regarding chronic wounds in those who exhibit behavioural and psychological symptoms of dementia.

RELEVANCE TO CLINICAL PRACTICE

Nurses that care for chronic wounds in PLWD can contribute their knowledge to include information in guidelines on best care practices and contribute their perspective to research teams for future research.

Cultural adaptation and reliability of the ISTAP Skin Tear Classification System to Chilean Spanish

OBJECTIVE

The International Skin Tear Advisory Panel (ISTAP) created the ISTAP Skin Tear Classification System with the aim of promoting a common and universal language to describe, classify and document skin tears, and increase awareness of the high prevalence of these wounds. Although there is a Spanish version of the ISTAP Skin Tear Classification System, the authors considered it relevant to have a specific Chilean Spanish version. The aim was to achieve the cultural adaptation of the ISTAP Skin Tear Classification System to Chilean Spanish, and verify its content validity and inter-rater reliability.

METHOD

The study consisted of two phases: cultural adaptation of the ISTAP Skin Tear Classification System into Chilean Spanish, and validation of the culturally adapted system. A convenience sample of 150 health professionals classified 30 photographs of skin tears, using the same photographs used in the original ISTAP skin tear classification and validation study. Additionally, the clinical application of the classification system was tested among 20 nurses, who assessed and classified the skin tears (n=24) of hospitalised patients. For analysis of the inter-rater reliability, Fleiss' kappa was used.

RESULTS

The differences found in the translation referred to a synonym of the terms 'skin' or 'cutaneous', and the terms 'flap' or 'tear'. Once analysed and discussed, the term 'desgarro' was maintained, which is the translation of the English term 'flap'. There is no equivalent term for 'skin tears' in Spanish, but consensus was reached by researchers and collaborators to use the phrase: 'desgarro de piel'. Once a consensus was reached on the wording for the translation, back-translation was completed and compared with the original English version and reviewed by the original author of the classification for accuracy. The content validity of the translated version of the ISTAP Skin Tear Classification System into Chilean Spanish showed a moderate agreement for the non-specialised nurses' group (0.4804) and for the specialised nurses' group (0.5308). Inter-rater reliability was achieved by obtaining a moderate agreement (Fleiss' kappa=0.53) and an almost perfect level of agreement for clinical application (Fleiss' kappa=0.83).

CONCLUSION

The reported content validity and inter-rater reliability support the applicability of the cultural adaptation of the ISTAP Skin Tear Classification System to Chilean Spanish into practice.

A cross-sectional study of characteristics of bicyclist upper and lower extremity injuries in bicycle-vehicle crashes in Ohio, United States, 2013-2017

Background

Extremity injury is one of the most common injury types for bicyclists. Extremity injury can lead to long-term disability and contribute to adverse health-related quality of life and prolonged absence from work.

Objectives

The objectives of our study were to identify crash factors associated with bicyclist upper and lower extremity injury and characterize type of extremity injury by bicyclist age category.

Methods

We linked the 2013–2017 Ohio police accident report and hospital databases. The logistic regression model was used to model the odds of sustaining upper or lower extremity injury among bicyclists involved in bicycle-vehicle crashes. Bicyclist upper and lower extremity injury were further described by the detailed injured body regions (e.g., forearm and elbow or lower leg) and the nature of injury (e.g., superficial or fracture).

Results

Bicyclists 65 years or older had higher odds (odds ratio [OR] = 1.46, 95% confidence interval [CI]: 1.03–2.08) of sustaining upper extremity injury, bicyclists aged 3–14 years (OR = 1.34, 95% CI: 1.09–1.66) and 15–24 years (OR = 1.24, 95% CI: 1.03–1.49) had higher odds of sustaining lower extremity injury, compared to bicyclists 25–44 years old. In addition, colder weather, bicyclist sex, and intersection-related crashes were associated with bicyclists’ odds of sustaining upper or lower extremity injury. Compared to individuals under 65 years old, bicyclists 65 years or older had a higher percentage of injury to the wrist, hand and finger, or knee. Bicyclists aged 65 years or older also had a higher percentage of fractures.

Conclusions

Our study has identified important factors that were associated with bicyclists’ odds of sustaining an extremity injury. Based on these findings, targeted educational efforts and interventions can be implemented to prevent bicyclists from these injuries.

Pretibial lacerations among elderly patients: A province-wide study from Kymenlaakso, Finland, 2015-2019

In this retrospective cohort study, we analysed treatment and outcomes among ≥65-year-old patients who experienced a traumatic pretibial laceration in the province of Kymenlaakso, Finland, between 2015 and 2019. We reviewed computerised medical records for 116 patients with a pretibial laceration, 107 of whom we analysed in further detail. Patients were traced from injury to healing, including rehabilitation periods in health care centres. As expected, the majority of patients were elderly women (67%). Most lacerations were superficial and small, explaining why treatment was mostly conservative. Only 11 (9.48%) patients were treated operatively with surgical debridement or a split-thickness skin graft. The number of overall complications in wounds was high, with a complication rate of 30.2%. Most complications were local wound infections. We found that wound healing took more than 3 months in 32% of patients. Thorough patient tracing revealed numerous follow-up visits and long rehabilitative hospitalisation periods, indicating a significant decline in patient independence and the excessive use of resources. Successful wound healing was eventually observed in 89.66% patients. Furthermore, no terminology regarding pretibial lacerations was found in patient records. This study indicates that pretibial lacerations remain poorly recognised and understood in Finland.

Applying Skin Barrier Film for Skin Tear Management in Patients with Central Venous Catheterization

OBJECTIVE

To examine and compare different methods of dressing change on skin tears at the periductal wound for ICU patients with central venous catheterization (CVC).

METHODS

This research used a quasi-experimental design. Participants included 98 patients from the ICU of a medical center in Taiwan using a convenience sampling technique from April 1, 2017 to March 31, 2018.

RESULTS

Applying skin barrier film at the CVC insertion site effectively protected the skin and significantly reduced the risk of skin tears among ICU patients (P < .01).

CONCLUSIONS

This study showed that use of skin barrier film at the site of CVC insertion can increase skin strength, maintain skin integrity, and decrease the incidence of skin tears. Skin barrier film is thus recommended for routine use in peripheral skin care for patients receiving CVC.

Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries

BACKGROUND

Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way.

OBJECTIVES

To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally.

METHODS

A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument.

RESULTS

A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75).

CONCLUSIONS

The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.

ISTAP classification for skin tears: Validation for Brazilian Portuguese

The objective of this study was to evaluate interobserver reliability and the concurrent criterion validity of the adapted version of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System to Brazilian Portuguese. For the evaluation of interobserver reliability using the photograph database, 36 nurses classified 30 skin tears (STs) into three groups, according to its definitions (adapted version). For the evaluation through clinical application, 23 nurses classified 12 STs present in 8 thoracic and cardiovascular postoperative patients at a tertiary hospital in Sao Paulo, Brazil. For the data collection of patients, an enterostomal therapist nurse classified the ST found by simultaneously using the adapted ISTAP version and the Skin Tear Audit Research (STAR) Classification System to test the concurrent criterion validity. The average of 17.83 correct answers (SD = 5.03) resulted from 1080 photograph observations, with Fleiss κ = 0.279 (reasonable concordance level). The interobserver reliability in the clinical application resulted in a global correct answer percentage of 76.7% in 85 observations. The concurrent criterion validity was attested by the total correlation (r = 1) between ISTAP and STAR. The ISTAP classification for ST is a reliable instrument and also valid in Brazil, making it another option to be used in clinical practice.

Skin tears: prevention and management

Skin tears commonly occur at the extremes of age and are associated with skin changes in ageing skin. They are considered to be acute wounds caused by mechanical forces, such as blunt trauma. While the true prevalence and incidence of skin tears is unknown, the available evidence suggests that these wounds occur in all healthcare settings. Importantly, skin tears are preventable with the implementation of a risk-reduction programme, which includes twice-daily skin moisturisation. Where these injuries do occur, it is important to categorise the extent of damage as well as to choose the most appropriate dressing to avoid adding any risks for further trauma.

Swedish translation and validation of the international skin tear advisory panel skin tear classification system

The aims of this study were to translate the International Skin Tear Advisory Panel (ISTAP) classification system for skin tears into Swedish and to validate the translated system. The research process consisted of two phases. Phase I involved the translation of the classification system, using the forward-back translation method, and a consensus survey. The survey dictated that the best Swedish translation for "skin tear" was "hudfliksskada." In Phase 2, the classification system was validated by health care professionals attending a wound care conference held in the spring of 2017 in Sweden. Thirty photographs representing three types of skin tear were presented to participants in random order. Participants were directed to classify the skin tear types in a data collection sheet. The results indicated a moderate level of agreement on classification of skin tears by type. Achieving moderate agreement for the ISTAP skin tear tool is an important milestone as it demonstrates the validity and reliability of the tool. Skin tear classification typing is a complex skill that requires training and time to develop. More education is required for all health care specialists on the classification of skin tears.

A risk model for the prediction of skin tears in aged care residents: A prospective cohort study

The objective of this study was to construct a predictive model to identify aged care residents at risk of future skin tears. Extensive data about individual characteristics, skin characteristics, and skin properties were gathered from 173 participants at baseline and at 6 months. A predictive model, developed using multivariable logistic regression, identified five variables that significantly predicted the risk of skin tear at 6 months. These included: a history of skin tears in the previous 12 months (OR 3.82 [1.64-8.90], P = 0.002), purpura ≤20 mm in size (OR 3.64 [1.42-9.35], P = 0.007), a history of falls in the previous 3 months (OR 3.37 [1.54-7.41], P = 0.002), clinical manifestations of elastosis (OR 3.19 [1.38-7.38], P = 0.007), and male gender (OR 3.08 [1.22-7.77], P = 0.017). The predictive model yielded an area under the receiver operating characteristic curve of 0.854 with an 81.7% sensitivity and an 81.4% specificity. This predictive model could inform a simple but promising bedside tool for identifying older individuals at risk of skin tears.

Improving the quality of life of aged care residents through the joy of food: The Lantern Project

OBJECTIVE

Mealtimes directly impact the quality of life of residents in aged care. The objective of The Lantern Project is to improve the dining experience of aged care residents to reduce malnutrition risk through improving dietary intake, meal.

METHODS

A transdisciplinary team of aged care professionals and resident advocates was formed as a collaboration collectively known as The Lantern Project.

RESULTS

This paper outlines the journey and timeline of The Lantern Project collaboration since its inception and the interplay between the monthly stakeholder meetings and inter-related research projects demonstrating improved outcomes.

CONCLUSION

Transdisciplinary collaboration offers well-grounded benefits and realistic strategies sensitive to the complexity of the aged care setting.

Restoration of the basement membrane after wounding: a hallmark of young human skin altered with aging

In skin, the basement membrane at the dermal-epidermal junction (DEJ-BM) is an important structure that tightly binds the epidermis to the dermis, and acts as a permeability barrier that controls exchange of macromolecules. Repair of the DEJ-BM during wound healing is important for restoration of skin functional properties after wounding. Here, we used a CO₂ laser to perform partial thickness wounds in human volunteers, and directly compared wound repair in healthy young and aged individuals, focusing on the DEJ-BM. Our results show that the DEJ-BM is restored within four weeks after partial thickness wounds in young adults. We identified laminin-γ2 as preferred substrate for keratinocytes during reepithelialization of partial thickness human wounds. Laminin-γ2 is expressed continuously by migrating keratinocytes during reepithelialization, whereas collagen IV and collagen VII are deposited after wound closure. In contrast, our study shows that the DEJ-BM restoration following wounding is deficient in elderly individuals. Specifically, COL7A2 was barely increased during wound repair in aged skin and, as a result, the DEJ-BM in elderly skin was not restored and showed abnormal structure. Our data suggest that ameliorating the quality of the DEJ-BM restoration is a promising therapeutic approach to improve the quality of repaired skin in the elderly.