Subepidermal moisture predicts erythema and stage 1 pressure ulcers in nursing home residents: a pilot study

J Am Geriatr Soc. 2007 Aug;55(8):1199-205. doi: 10.1111/j.1532-5415.2007.01261.x.


Objectives: To examine the relationship between a measure of subepidermal moisture (SEM) and visual skin assessment (VSA) of erythema and Stage 1 pressure ulcers (PUs) performed a week later in nursing home (NH) residents.

Design: Descriptive, cohort study.

Setting: Two NHs.

Participants: Thirty-five residents.

Methods: Concurrent VSAs and SEM readings were obtained at the sacrum, right and left trochanters, buttocks, and ischial tuberosities weekly for 52 weeks. SEM was measured using a handheld dermal phase meter, with higher readings indicating greater SEM (range 0-999 dermal phase units [DPUs]). VSA was rated as normal, erythema/Stage 1 PU, or Stage 2+PU. SEM was modeled as a predictor of VSA of erythema and PUs 1 week later (controlling for clustering), with concurrent moisture, Braden Scale PU risk status, anatomic site, and ethnicity as covariates.

Results: Participants had a mean age of 84.7, 83% were female, and 80% were non-Hispanic white. SEM measures were lowest for normal skin (97+/-122 DPU), higher for erythema/Stage 1 PUs (192+/-188 DPU), and highest for Stage 2+PUs (569+/-320 DPU) across all sites (all P<.001). SEM was responsive to changes in VSA, and higher SEM predicted greater likelihood of erythema/Stage 1 PU the next week (odds ratio=1.26 for every 100-DPU increase in SEM, P=.04).

Conclusion: SEM measures are associated with concurrent erythema and PUs and future (1 week later) development of erythema/Stage 1 PUs. SEM may assist in predicting early PU damage, allowing for earlier intervention to prevent skin damage.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Cohort Studies
  • Disease Progression
  • Early Diagnosis
  • Epidermis / physiology*
  • Erythema / complications
  • Erythema / diagnosis*
  • Female
  • Homes for the Aged
  • Humans
  • Male
  • Nursing Homes
  • Pilot Projects
  • Predictive Value of Tests
  • Pressure Ulcer / complications
  • Pressure Ulcer / diagnosis*