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Ostomy Wound Manage. 2018 Sep;64(9):12-27.

An Observational, Prospective Cohort Pilot Study to Compare the Use of Subepidermal Moisture Measurements Versus Ultrasound and Visual Skin Assessments for Early Detection of Pressure Injury.

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Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
Gershon Pain Specialists, LLC, Virginia Beach, VA.


Pressure ulcers (PUs) are detected by visual skin assessment (VSA). Evidence suggests ultrasound (US) and subepidermal moisture (SEM) scanner technology can measure tissue damage before it is visible.


A pilot study was conducted to evaluate consistency between SEM and US examinations of suspected deep tissue injury (sDTI).


Using an observational, prospective cohort study design, patients >55 years of age were recruited. VSA, SEM, and US assessments were performed daily for a minimum of 3 and maximum of 10 consecutive days following enrollment. US results were considered indicative of sDTI if hypoechoic lesions were present. SEM readings were considered abnormal when ∆ ≥0.6 was noted for at least 2 consecutive days. Boolean analysis was utilized to systematically determine consistency between US and SEM where sDTI was the clinical judgment.


Among the 15 participants (10 women, mean age 74 ± 10.9 years), there was consistent agreement between SEM and US when sDTIs existed. For 1 patient who developed a heel sDTI during the study, SEM readings were abnormal 2 days before VSA indicated tissue damage and 3 days before the appearance of a hypoechoic lesion in the US.


US and SEM results were similar, and in an evolving sDTI case, SEM detected a lesion earlier than US.

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