Phantom testing of the sensitivity and precision of a sub-epidermal moisture scanner

Int Wound J. 2019 Aug;16(4):979-988. doi: 10.1111/iwj.13132. Epub 2019 Apr 16.


The majority of pressure ulcers (PUs) including deep tissue injuries (DTIs) are preventable, and even reversible if detected in their early phase. One of the greatest barriers in PU prevention is that clinicians traditionally depended on subjective and qualitative techniques, particularly routine visual skin assessments that would only document existing, macroscopic PUs/DTIs, rather than preventing them or detecting them at their microscopic phase. At the early phase of cell damage, when a forming PU is still microscopic, there is a local increase in extracellular fluid contents within affected tissues, which is called sub-epidermal moisture (SEM). This new understanding has led to an emerging technology, a SEM Scanner (BBI LLC, Bruin Biometrics) that has been designed to effectively examine the health status of tissues, by measuring local changes in the biophysical SEM marker. In the present work, the SEM Scanner was tested under controlled laboratory conditions to experimentally determine its sensitivity and precision in identifying small (1 mL) water content changes in phantoms of the human heel and skull/face, which simulated common PU development scenarios. In both phantom configurations, the locally increased water contents resulted in consistent, statistically significant elevated SEM readings, which confirms that the SEM Scanner is able to detect fluid content changes that are as small as 1 mL. In agreement with a simplified theoretical (mathematical) SEM model, which was also developed here, changes in water contents had a consistent trend of effect on SEM delta values, which increased with each 1 mL increment in intra-tissue-substitute water contents.

Keywords: inflammatory response; oedema; pressure ulcer prevention; prophylaxis.

MeSH terms

  • Early Diagnosis*
  • Edema / physiopathology*
  • Epidermal Cells / physiology*
  • Extracellular Fluid / physiology*
  • Humans
  • Monitoring, Physiologic / instrumentation*
  • Monitoring, Physiologic / methods*
  • Pressure Ulcer / prevention & control*
  • Sensitivity and Specificity