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Exploring Methods to Improve Pressure Ulcer Detection: Spectroscopic Assessment of the Blanch Response

Zanca, Jeanne M. (2006) Exploring Methods to Improve Pressure Ulcer Detection: Spectroscopic Assessment of the Blanch Response. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Pressure damage in intact skin is difficult to detect, particularly in individuals with dark skin, because color changes and tissue blanching are masked by the skin's pigmentation. Tissue reflectance spectroscopy (TRS) may be able to detect the blanch response regardless of skin color by measuring the change in total hemoglobin (delta tHb) that occurs when pressure is applied to the skin. The objective of this dissertation was to examine the ability of TRS to detect the blanch response at sites at risk for pressure ulcer development in individuals with various levels of skin pigmentation. Three studies were conducted to address this objective. In Study 1, delta tHb was assessed at the heel and sacrum of light and dark-skinned healthy participants using a portable TRS system. Study 1 showed that a significant decrease (p less than 0.001) in tHb could be measured in both light and dark skinned-participants with good intra-rater reliability (ICC greater than or equal to 0.80) at the heel, but not at the sacrum. Study 2 was conducted to identify a reliable method of skin color description for use in subsequent studies of the spectroscopic blanch response. Two examiners (B and C) performed three skin color assessments at the volar forearm of ten healthy participants using Munsell color tile matching and colorimetry. Intra and inter-rater reliability was excellent for colorimetry (ICCs typically greater than or equal to 0.90). Reliability for Munsell color tile matching was highest for Munsell value within Examiner B (93% agreement, kappa 0.87-1.00), which was determined to be sufficiently high for use in subsequent studies. In Study 3, delta tHb was assessed at the heels of light, moderate, and dark-skinned elderly nursing home residents at risk for pressure ulcers. As in the pilot study, a significant decrease in tHb was observed in all skin color groups (p less than 0.05). Intra-rater reliability for delta tHb was moderate or greater (ICC greater than or equal to 0.61). In combination, the results of Study 1 and Study 3 demonstrated that a significant spectroscopic blanch response could be detected with moderate or greater intra-rater reliability at the heel regardless of age or pressure ulcer risk status.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Zanca, Jeanne
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBrienza, David Mdbrienza@pitt.eduDBRIENZA
Committee MemberSampson, Allan Rasampson@stat.pitt.eduASAMPSON
Committee MemberHolm, Margo Bmbholm@pitt.eduMBHOLM
Committee MemberSowa, Michael
Date: 8 September 2006
Date Type: Completion
Defense Date: 17 July 2006
Approval Date: 8 September 2006
Submission Date: 1 August 2006
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: colorimetry; reliability; skin color; hemoglobin; Munsell color-order system; tissue reflectance spectroscopy
Other ID:, etd-08012006-153211
Date Deposited: 10 Nov 2011 19:55
Last Modified: 15 Nov 2016 13:47


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