Evaluating the Use of a Skin Failure Indicator Scale in the Diagnosis of Acute Skin Failure

Background. Critically ill patients are at increased risk of skin breakdown that may occur in non-pressure locations. Recognition of skin failure as distinct from hospital-acquired pressure injuries (HAPIs) may have significant clinical, financial, and legal implications. Objective. To apply a novel diagnostic scale in the care of patients with pressure injuries to determine its utility in diagnosing skin failure at a quaternary hospital. Materials and Methods. Critically ill patients at a quaternary hospital from September 2022 through November 2023 with a HAPI diagnosis were included. Charts were retrospectively reviewed for demographics, clinical outcomes, and wound parameters. Skin failure was evaluated using the Hill and Petersen Skin Failure Clinical Indicator Scale (SFCIS), with patients with a score of 15 to 21 considered to have high probability of skin failure. Results. During the study period, 12 patients were found to meet criteria for skin failure. For those patients, the mean length of stay was 58 days. All patients scored above 15 on the SFCIS, with 3 patients scoring 21 and 9 patients scoring 18. All patients met criteria for impaired blood flow and sepsis or multisystem organ dysfunction syndrome. Four patients met criteria for moderate or severe protein calorie malnutrition with an albumin level of less than 3.5 g/dL. Ten patients received mechanical ventilation for more than 72 hours. Conclusion. Twelve patients who were identified has having HAPIs were reclassified as having skin failure using the SFCIS. Further work is necessary to validate this scoring system in diagnosing skin failure and the implications associated with its use.