Dissertation/Thesis
Standardizing Skin Failure Assessment: Differentiating Acute Skin Failure from Hospital- Acquired Pressure Injuries
| Title: | Standardizing Skin Failure Assessment: Differentiating Acute Skin Failure from Hospital- Acquired Pressure Injuries |
|---|---|
| Authors: | Stewart, Kylie B |
| Source: | Graduate Theses, Dissertations, and Capstones |
| Publisher Information: | ScholarWorks@Bellarmine |
| Publication Year: | 2026 |
| Collection: | Bellarmine University: ScholarWorks@Bellarmine |
| Subject Terms: | acute skin failure, hospital-acquired pressure injury, Skin Failure Clinical Indicator Scale, critical care, in-hospital mortality, pressure injury classification, Critical Care Nursing, Palliative Care, Palliative Nursing |
| Description: | Background: Acute skin failure (ASF) can mimic a hospital-acquired pressure injury (HAPI), particularly among critically ill patients experiencing hypoperfusion and multisystem organ dysfunction. The lack of a standardized diagnostic approach may contribute to misclassification, inappropriate interventions, and inaccurate quality reporting. Purpose: This study evaluated the use of the Skin Failure Clinical Indicator Scale (SFCIS) to identify skin injuries potentially consistent with ASF that would support reclassification. This study also examined associations between SFCIS scores, in-hospital mortality, length of stay, and individual comorbidities. Methods: A retrospective chart review was conducted at a 32-bed adult intensive care unit in a suburban hospital in the southeastern United States. The final sample included 35 adult patients admitted between 2023 and 2025 who developed a Stage 3, Stage 4, unstageable, or deep tissue pressure injury (DTPI) attributed to their ICU stay. Patients were classified as high risk or non-high risk using the SFCIS. Descriptive statistics, Fisher’s exact tests, Wilcoxon rank-sum tests, Spearman correlations, and univariate logistic regression were used to analyze the data. Results: Twenty-two patients (62.9%) were classified as high risk for ASF. In-hospital mortality was significantly higher among high-risk patients than among non-high-risk patients (55.0% vs. 7.7%, p = .010). Each 1-point increase in SFCIS score was associated with a 19% increase in the odds of in-hospital mortality (OR = 1.19, 95% CI [1.04, 1.43], p = .031). Higher SFCIS scores were also associated with longer hospital stays (Spearman’s ρ = .373, p = .027) and ICU stays (ρ = .536, p < .001). Application of the SFCIS supported potential reclassification of 22 of 87 identified HAPIs (25.3%) as ASF and would have reduced reportable PSI-03 eligible pressure injuries by 50%. Conclusion: The SFCIS may provide a clinically meaningful, standardized method for identifying ASF among critically ill patients. Its ... |
| Document Type: | Thesis |
| File Description: | application/pdf |
| Language: | unknown |
| Relation: | https://scholarworks.bellarmine.edu/tdc/232; https://scholarworks.bellarmine.edu/context/tdc/article/1240/viewcontent/KBS.Manuscript.pdf |
| Availability: | https://scholarworks.bellarmine.edu/tdc/232 https://scholarworks.bellarmine.edu/context/tdc/article/1240/viewcontent/KBS.Manuscript.pdf |
| Accession Number: | edsbas.412A2B92 |
| Database: | BASE |
| Description not available. |