Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study.
Maria-Elena García-Manzanares, Margarita Lancharro-Bermúdez, Blanca Fernandez-Lasquetty-Blanc and 3 others
PMID 36394252WHAT IT FOUND
Nurses assessing ostomy skin lesions remotely agreed only for clear signs and diagnoses.
They often disagreed about candidiasis, bacterial superinfection, foam or silicone dressings, so remote assessment needs extra clinical details.
Key findings
01Remote assessment agreement was high for encrustation, nodules, mucocutaneous separation and varicose veins, but low for obstruction, purulent exudate, maceration and blisters.
02Diagnosis agreement was high for mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins, but low for candidiasis, psoriasis, bacterial superinfection and friction/pressure ulcer.
03Care indication agreement was high for a diet rich in vitamin C/blueberries, acetic acid dressings, applying cold and topical tacrolimus, but low for foam dressing, silicone dressing, increasing water intake and reducing soluble fibre intake.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 32 patients and 39 nurses took part, so the study was small and hard to generalise. The kappa agreement measure depends on lesion prevalence and the large number of categories; the authors say it is descriptive rather than useful for inference. Some lesions were rare and difficult to assess, especially for nurses working in hospitals with fewer cases. The reference standard was the recruiting stoma therapy nurse's own assessment, not an independent diagnostic test. Nurses may have remembered their own first assessment when repeating it after 30 days. Lighting and focus of the photographs may have influenced agreement. Assessment remained subjective despite a glossary; the authors say validated tools for assessing peristomal skin would help.
Declared interests
The authors declared no conflicts of interest and reported no specific funding.
The easy way to misread this
Do not conclude that remote photos are enough to diagnose or treat peristomal skin lesions. Agreement was low for obstruction, maceration, blisters, purulent exudate, candidiasis, bacterial superinfection, friction/pressure ulcer, foam dressing and silicone dressing, and the paper says images often need additional clinical information.