The Relationship Between Subepidermal Moisture Assessment and Pain Measurements in Predicting Pressure Ulcer Development in At-Risk Adults

Abstract

The relationship between subepidermal moisture (SEM) assessment and pain as early indicators of pressure ulcer development remains unclear. This study aimed to investigate the association between SEM, pain, and visual skin assessment (VSA) in adults at risk of pressure ulcer development. A prospective cohort study was undertaken in a medical-surgical ward of an acute hospital in Dublin, Ireland. Adults identified as being at risk of pressure ulcer development or scheduled for surgery requiring a minimum two-night stay were recruited following informed consent. Participants underwent SEM assessment, pain assessment, and VSA at baseline and daily for three consecutive days. Spearman's rank correlation coefficient was used to examine relationships between SEM, pain, and VSA. Thirty-seven participants were included, with a mean age of 63 years (SD 17.88); 59.5% were male. The incidence of pressure ulcer development identified through VSA was 5.4% (n = 2), whereas SEM identified abnormalities in 89.2% (n = 33) of participants. A negligible correlation was observed between pain and SEM measurements, and between pain and VSA. SEM values varied across Fitzpatrick skin types; however, no consistent relationship between skin tone and SEM measurements was observed. These findings indicate that pain may have limited utility as an early indicator of pressure ulcer development. SEM identified tissue abnormalities more frequently than VSA and appeared to perform consistently across skin tones, supporting its potential role in the early detection of pressure-related tissue damage.