The National Pressure Ulcer Advisory Panel (NPIAP)’s science paper on pressure injuries among people with dark skin tones has been published in Advances in Skin and Wound Care (ASWC).

In an Aug. 25 news announcement, the NPIAP said the paper covers “increased incidence and poorer outcomes of pressure injury in patients with dark skin tones.”

The announcement added, “NPIAP did some of the earliest work in the late 1990s, identifying the issues surrounding higher rates of full thickness PI [pressure injury] in persons with dark skin tones. Over the intervening years, NPIAP and others have continued to research the problem.

“At this year’s NPIAP meeting in San Diego, the issue of identification of stage 1 and deep tissue pressure injury in persons with dark skin tones was again discussed. Today, we have methods to augment visual assessment of skin which helps to identify early signs of stage 1 and deep tissue injury. The paper summarizes that work and clearly highlights the issues that all health professionals should be addressing.”

While pressure injury assessment has long included visually checking patients’ skin for redness, for example, the paper discusses why that method might not work as well when patients have darker skin tones. In the mid 1990s, the paper said, clinicians “noted that assessments that identify a stage 1 PI such as ‘erythema’ and ‘nonblanchable erythema’ are not always visible in patients with dark skin tones and therefore, other indicators of stage 1 PI are needed.”

The NPIAP task force convened to study the issues agreed on several assumptions, including “Intact skin has a variety of color changes; very darkly pigmented skin does not have visible blanching; and other objective findings of stage 1 PI could include temperature changes (warmth, coolness, edema, induration).”

Among the conclusions that researchers drew: There is a “gap in our clinical knowledge” regarding pressure injuries occurring among patients with dark skin tones. “Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones,” the paper added. “Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.”

Through November, the paper is available for free through open access on the ASWC Web site.