Comparing visual and objective skin assessment with pressure injury risk

Objective biophysical measures that assess skin hydration, melanin, erythema and lipids have not been traditionally used in PI risk; however, these may prove useful as part of risk assessment. The relationship between subjective visual assessment of skin condition, biophysical measures, and PI risk warrants investigation. This study used a descriptive correlational design to examine the relationship between measures of skin hydration, colour (melanin and erythema), and lipids at PI-prone areas amongst geriatric persons (n=38), obtained using biophysical skin measures and visual skin assessment. Twice daily measures of hydration, colour and lipids were assessed using a diagnostic skin device over pressure-prone areas of participants over seven consecutive days. Concurrent visual assessment of hydration and colour was performed. Results obtained using the diagnostic skin device were compared with results gathered from visual assessment and examined for their association with participants’ PI risk based on Norton Risk Assessment Scale scores. While epidermal hydration and skin colour readings did not vary significantly over the data collection period, lipid readings could not be registered on any occasion. With the exception of skin dryness, skin parameters obtained via both objective and subjective means had significant, positive correlations. Statistically significant correlations emerged between visual assessment of skin wetness at the sacrum (r=−0⋅441, P<0⋅01) and ischia (r=−0⋅468, P<0⋅01) and Norton Risk Assessment Scale scores. It was found that the objective assessment of hydration (skin wetness) was also significantly associated with PI risk at the sacrum (r=−0⋅528, P<0⋅01), as well as the right ischia (r=−0⋅410, P<0⋅05) and left ischia (r=−0⋅407, P<0⋅05). Erythema, when assessed objectively, was significantly correlated with PI risk at the sacrum (r=−0⋅322, P<0⋅05). Such findings indicate that the finer measures afforded by the diagnostic skin device in the assessment of the subtle red hues displayed in erythematous skin may provide an additional advantage over traditional, clinician assessment.