suspected deep tissue injury, pressure ulcers, pressure ulcer staging



  1. Honaker, Jeremy BSN, RN, CWOCN
  2. Brockopp, Dorothy PhD, RN
  3. Moe, Krista PhD


PURPOSE: To enhance the learner's competence with knowledge of the results of research examining suspected deep tissue injury profiles.


TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.


OBJECTIVES: After participating in this educational activity, the participant should be better able to:


1. Identify assessment tools and literature reviews of precipitating and contributing factors for suspected deep tissue injury (SDTI).


2. Analyze data findings of precipitating and contributing factors for prediction for SDTI development based on this study's data.





OBJECTIVE: The purpose of this study was to examine (1) the incidence of potential precipitating events of suspected deep tissue injuries (SDTIs) identified over a 7-day period prior to cutaneous manifestation, (2) physiological variables related to the formation of SDTIs, and (3) the time since precipitating events and the occurrence of the SDTI.


DESIGN: A descriptive exploratory study. A retrospective chart review was conducted.


SETTING: A 348-bed community Magnet-redesignated hospital, Baptist Health Lexington Kentucky


PARTICPANTS: Eighty-five participants with SDTIs identified between January 2008 and March 2010.


MAIN OUTCOME MEASURES: Precipitating events evaluated were tissue perfusion, surgery, transfers, mobility, and falls. Physiological variables included anticoagulation, albumin/prealbumin, hemoglobin, partial thromboplastin time, and hemoglobin A1c. Timeline differences between precipitating events and SDTI were measured.


MAIN RESULTS: Precipitating events identified from most to least frequent were transfers = 67 (78.8%), tissue perfusion = 36 (42.5%), surgery = 33 (40.2%), mobility = 26 (30.9%), and falls = 14 (16.9%). Of the 85 charts reviewed, 69 of the charts met the criteria for timeline difference between precipitating event and SDTI manifestation. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) years. Meaningful physiological variables noted were anticoagulation 52 (61.2%), anemia (hemoglobin 6-9 g/dL) 53 (67.1%), and hemoglobin A1c less than 7.5 mmol/L 29 (74.4%).


CONCLUSIONS: This exploratory pilot study evaluating patients with SDTI revealed the most common precipitating event was transfers. In addition, the physiological variables that appeared to contribute to the development of SDTIs were anticoagulation and anemia. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) days.