Melissa Zimmermann-Vildoso, Javier Devia-González, Paula Cristina Nogueira, Vanessa de Brito Poveda
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The evaluation of skin failure should be based on specific clinical characteristics to strengthen the knowledge of this phenomenon and to set standards of care.</p><p><strong>Objective: </strong>To evaluate the available evidence about characteristics of and clinical instruments for skin failure diagnosis and evaluation in adult patients with advanced or end-stage disease.</p><p><strong>Methods: </strong>Between April 4 and May 18 2023, a scoping review was conducted and included literature on skin failure classification and diagnosis in patients aged 18 years or older in any health context. Articles that included a pediatric population or dermatologic diagnoses not related to the current concept of skin failure and articles referring only to a theoretical definition of skin failure were excluded. The databases searched were PubMed, CINAHL, Web of Science, LILACS, ScienceDirect, and the Cochrane Database of Systematic Reviews. Grey literature was retrieved via the \"DART E-theses Portal\" and \"CAPES Thesis Portal.\"</p><p><strong>Results: </strong>A total of 196 articles were identified. The final sample included 8 studies related to the theoretical concept of skin failure. The most cited factors related to acute skin failure were sepsis, hypoperfusion, vasopressor use, oxygenation, nutritional status, acute organ compromise, mechanical ventilation, and chronic diseases. One specific tool was identified to assess skin failure that included the same characteristics revealed by this scoping review.</p><p><strong>Conclusion: </strong>There is limited evidence regarding clinical indicators for the evaluation of skin failure. The results of this exploratory review suggest specific clinical features of skin failure which may consider other elements than those related to pressure injuries. 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引用次数: 0
摘要
背景：在临床环境中，皮肤衰竭一词的使用有限；然而，质疑皮肤衰竭和其他损伤（如压伤）之间的区别是合理的。皮肤衰竭的评估应基于具体的临床特征，以加强对这一现象的认识，并制定护理标准。目的：评价成人晚期或终末期皮肤病患者皮肤衰竭诊断和评价的特点和临床仪器。方法：在2023年4月4日至5月18日期间，进行了一项范围综述，并纳入了18岁及以上任何健康背景下患者皮肤衰竭分类和诊断的文献。包括儿科人群或皮肤病学诊断与当前皮肤衰竭概念无关的文章以及仅涉及皮肤衰竭理论定义的文章被排除在外。检索的数据库包括PubMed、CINAHL、Web of Science、LILACS、ScienceDirect和Cochrane系统评价数据库。灰色文献通过“DART e - Thesis Portal”和“CAPES Thesis Portal”检索。结果：共鉴定出196篇文献。最终样本包括8项与皮肤衰竭理论概念相关的研究。与急性皮肤衰竭相关的最常见因素是败血症、灌注不足、血管加压药的使用、氧合、营养状况、急性器官损害、机械通气和慢性疾病。我们确定了一种评估皮肤衰竭的特定工具，该工具包含了本综述所揭示的相同特征。结论：评价皮肤衰竭的临床指标证据有限。本探索性综述的结果表明，皮肤衰竭的特定临床特征可能考虑其他因素，而不是与压力损伤相关的因素。需要进行初步研究，以加强对皮肤衰竭的诊断，并将其纳入疾病任何阶段的常规保健实践。
Skin failure clinical characteristics and clinical instruments for diagnosis in adult patients with advanced or terminal diseases: a scoping review.
Background: There is limited use of the term skin failure in the clinical setting; however, it is valid to question the differences between skin failure and other injuries (eg, pressure injuries). The evaluation of skin failure should be based on specific clinical characteristics to strengthen the knowledge of this phenomenon and to set standards of care.
Objective: To evaluate the available evidence about characteristics of and clinical instruments for skin failure diagnosis and evaluation in adult patients with advanced or end-stage disease.
Methods: Between April 4 and May 18 2023, a scoping review was conducted and included literature on skin failure classification and diagnosis in patients aged 18 years or older in any health context. Articles that included a pediatric population or dermatologic diagnoses not related to the current concept of skin failure and articles referring only to a theoretical definition of skin failure were excluded. The databases searched were PubMed, CINAHL, Web of Science, LILACS, ScienceDirect, and the Cochrane Database of Systematic Reviews. Grey literature was retrieved via the "DART E-theses Portal" and "CAPES Thesis Portal."
Results: A total of 196 articles were identified. The final sample included 8 studies related to the theoretical concept of skin failure. The most cited factors related to acute skin failure were sepsis, hypoperfusion, vasopressor use, oxygenation, nutritional status, acute organ compromise, mechanical ventilation, and chronic diseases. One specific tool was identified to assess skin failure that included the same characteristics revealed by this scoping review.
Conclusion: There is limited evidence regarding clinical indicators for the evaluation of skin failure. The results of this exploratory review suggest specific clinical features of skin failure which may consider other elements than those related to pressure injuries. Primary studies are needed to strengthen the diagnosis of skin failure and its inclusion in routine health care practice at any stage of disease.
期刊介绍：
Wounds is the most widely read, peer-reviewed journal focusing on wound care and wound research. The information disseminated to our readers includes valuable research and commentaries on tissue repair and regeneration, biology and biochemistry of wound healing, and clinical management of various wound etiologies.
Our multidisciplinary readership consists of dermatologists, general surgeons, plastic surgeons, vascular surgeons, internal medicine/family practitioners, podiatrists, gerontologists, researchers in industry or academia (PhDs), orthopedic surgeons, infectious disease physicians, nurse practitioners, and physician assistants. These practitioners must be well equipped to deal with a myriad of chronic wound conditions affecting their patients including vascular disease, diabetes, obesity, dermatological disorders, and more.
Whether dealing with a traumatic wound, a surgical or non-skin wound, a burn injury, or a diabetic foot ulcer, wound care professionals turn to Wounds for the latest in research and practice in this ever-growing field of medicine.
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