The Relationship Between Sub Epidermal Moisture (SEM) Measurement and Inflammatory Markers in the Early Identification of Pressure Ulcers
Creators: name: McEvoy, Natalie
Publisher: name: Royal College of Surgeons in Ireland
Year: 2022
Subjects: subject: 111002 Clinical Nursing: Primary (Preventative)
subject: FOS: Health sciences

description: <strong>Introduction:</strong> Pressure ulcer (PU) prevention in the intensive care unit (ICU) is a particularly important clinical issue as ICU patients are at high risk of developing PUs. However, current methods of PU detection are limited. The current gold standard of PU detection involves visual skin assessment (VSA). Reliance on VSA as a method of PU detection is problematic given that PUs’ often develop from within the deeper tissues at a microscopic rather than macroscopic level. Further research into the early methods of PU detection are needed in order to facilitate an objective approach to diagnosis, thus leading to the implementation of prevention strategies to prevent progression of PUs. <strong>Methods:</strong> The aim of this study was to establish the correlation between IL- 1α, total protein (TP) and Sub Epidermal Moisture (SEM) measurements in the early identification of PUs in ICU patients. This study involved the sampling of sebum using Sebutape and measurement of SEM from skin sites (sacrum, heels and a control site). SEM measurements and Sebutape samples were taken at the same time points, to assess any potential associations between these inflammatory measurement approaches in the detection of inflammation as part of the PU development phase. Five healthy volunteers were also recruited to the study. SEM and Sebutape readings were taken at the same anatomical locations as the ICU patients. <strong>Results:</strong> The study was conducted on 53 participants (equating to 783 measures) admitted to ICU in a large hospital in the Republic of Ireland. The mean baseline SEM delta measurements among the study participants indicate abnormal SEM deltas for all anatomical sites except the control site, where the reading was considered normal. Mean baseline IL-1α/TP readings were higher for the sacrum versus the right heel and left heel. Further, on average, IL-1α/TP readings were higher for the control site versus all other anatomical locations. Results demonstrated that there was very weak or weak correlations between SEM delta measurements and IL-1α/TP readings on all the study days, for all anatomical locations. Further, these correlations were not statistically significant. In the healthy volunteers, all mean SEM delta measurements were within normal limits. IL-1α/TP readings were higher for the sacrum versus the right heel and left heel. Further, IL-1α/TP readings were higher for the control site versus all other anatomical locations. Results showed a strong positive correlation between for the right heel and the left heel. Conversely, there was a very strong negative correlation for the sacrum, and a weak negative correlation for the control site. <strong>Conclusions:</strong> This study provides important information on not only the relationship between IL-1α/TP and SEM measurements as potential biomarkers in the early detection of PUs in adult ICU patients, but also sheds light on the feasibility of these methods in the ICU setting. Results from this study are consistent with findings from previous studies in terms of SEM delta measurements. There is a need for a quick, easy, and objective measure of PU development. It is evident from conducting this study that obtaining SEM measurements, is more practical and feasible than Sebutape sampling to assess for the presence of inflammation.