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

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


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.

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

Method: 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.

Results: 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.

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

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Early Diagnosis
  • Female
  • Humans
  • Humidity*
  • Male
  • Middle Aged
  • Pilot Projects
  • Pressure Ulcer / diagnosis*
  • Pressure Ulcer / nursing
  • Pressure Ulcer / prevention & control
  • Prospective Studies
  • Skin Care / instrumentation*
  • Skin Care / methods
  • Ultrasonography / methods
  • Ultrasonography / standards