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J Wound Ostomy Continence Nurs. 2011 Nov-Dec;38(6):655-60. doi: 10.1097/WON.0b013e31823429e7.

Suspected deep tissue injury evaluated by North Carolina WOC nurses: a descriptive study.

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  • 1Duke University Medical Center, Durham, North Carolina 27710, USA.



The purpose of this prospective exploratory study was to determine the percentage of suspected deep tissue injuries (sDTI) that evolve into full-thickness skin loss, to describe the progression from sDTI to full-thickness skin loss, and to explore associated conditions.


The study was conducted by WOC nurses at 6 acute care medical facilities in North Carolina. Inclusion criteria were age 21 years or older and presence of an sDTI lesion. Participating members of the North Carolina WOC Nurse's Group identified 40 patients with a total of 45 sDTI.


A 2-part data collection tool was developed by 1 of the investigators and validated by members of the North Carolina WOC Nurse Group; data were collected at the time of initial consult and at a follow-up visit that occurred 1 to 20 days later (average 6 days). Data collected included description of wound appearance as well as information about comorbid and potential risk factors.


The sample comprised 40 subjects with 45 sDTI; 3 were lost to follow-up, resulting in a total of 37 subjects with 42 sDTI at the second assessment. Eleven (26%) sDTI developed into full-thickness skin loss, and 7 (17%) evolved from purple/maroon discoloration to thin blisters over dark wound beds. Twenty (48%) did not change between the time of initial consult and the follow-up visit up between 1 and 20 days later. Two lesions healed (1 at 6 days and the other at 8 days).


Despite preventive care, 26% of the sDTI evolved into full-thickness lesions at follow-up visit, and 17% evolved into unstageable pressure ulcers. However, 5% healed and 48% remained the same, suggesting that preventive care may be effective for many sDTI lesions.

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