Multicenter observational study on peristomal skin disorders

Multicenter

Observational Study on

Peristomal Skin

Disorders:

A Proposal of

Classification

17 World Council of Enterostomal Therapist (WCET)

Congress

“All roads lead us together”

Mario Antonini

ET Nurse – U.S.L. 11 Local Health Agency – San Giuseppe Hospital, Empoli, Italy

[email protected]

“How well ostomy patients adapt to their new life depends, to a great

extent, on the preservation of peristomal skin integrity”

Multicenter Observational Study on Peristomal Skin Disorders:

A Proposal of Classification

The incidence of peristomal complications that can compromise that integrity cannot

be easily determined.

*A review of literature indicates a complication incidence ranging from 18%

to 55%.

* Colwell J, Goldberg M, Carmel J. The state of the standard diversion. JOWCN

2001; 28 (1): 6-17



“In the authors experience caring for nearly 700 patients per year over a mean period of 10 years, it is estimated that at least one third of colostomy patients and up to two thirds of urostomy and ileostomy patients are affected by at

least on peristomal lesion.”



“Because the literature shows no evidence of a tool classify peristomal

skin disorders, a prospective observational study was conducted among

eight ostomy centers across Italy.”



“A study group comprised of seven enterostomal therapy nurses and four

surgeons sought to provide an objective, reproducible, standardized classification

instrument.”



Ambulatorio Stomaterapia

Ospedale “San Giovanni

Battista”

Le Molinette – Torino\


Ospedale “San Giuseppe” –

Azienda U.S.L. 11 Empoli


Azienda Ospedaliera

“Garibaldi” - Catania

Presidio Ospedaliero “San

Luigi Curro” - Catania

Ospedale “Piemonte” - Messina


Azienda Ospedaliera “San

Maurizio” - Bolzano


Ospedale “Misericordia e

Dolce” – Azienda U.S.L. 4

Prato


Policlinico Universitario

“Campus Biomedico” - Roma

Ostomy Centers across Italy



This study was published in the Journal

OWM - OSTOMY WOUND MANAGEMENT

A proposal for classifying peristomal skin disorders: results of a

multicenters observational study

2007; 53(9): 38-43

Skin lesions were examined at set intervals (weeks 0, 4, 12, 24)

Acquisition of digital images

Blood chemistry

Descriptive statistical analyses were conducted using the software SPSS 14.0

Consensus Conferences



Multicenter Observational Study on Peristomal Skin Disorders

Patient Demographic Group 1

<1 year after surgery

Time 0

Patien

t PARAMETRI CLINICI

Name Data Pictu

re

Blood

sugar

Blood

Iron Hemoglobin

Body

Weight

(kg)

Diuretic Bleeding at

removal Degree of Peristomal skin lesion (1,2,3,4,X) Burning

Itching

Pain Bleeding Localization

001

002

003

004

005

006

007

008

009

010

011

012

013

014

015

016

017

018

019

020

December

2003

February

2006



A prospective, observational study was conducted between December 2003 and February 2006.


<1 year after surgery

(N = 380)

Gender (%) Male: 60%

Female: 40%

Age Minimum: 25 years

Maximum: 85 years

Stoma type (%)

- Ileostomy

- Colostomy

28,6%

71,4%

Permanent stoma

Temporary stoma

62,6%

37,8%

Systemic disease Cardiopathy: 9,1%

Arterial Hypertension: 8%

Diabetes: 11,2%


>1 year after surgery

(N = 276)

Gender (%) Male: 65%

Female: 35%

Age Minimum: 26 years

Maximum: 91 years

Stoma type (%)

- Ileostomy

- Colostomy

31,9%

68,1%

Permanent stoma

Temporary stoma

87,5%

12,5%

Systemic disease Cardiopathy: 4,2%

Arterial Hypertension: 8%

Diabetes: 11%

Peristomal: the term “peristomal” is meant to include the whole skin around the stoma (within 7,5 cm, which is the maximum size of the skin barriers available in the market), even if it is not directly linked with the stoma.

Predominant sign: it was decided that the classification should only refer to the predominant sign (the most serious one) and the topography (T) of the lesion; the classification will then include only one “L” and in case more than one “T”.



The peristomal complication classification system developers

agreed to identify the quadrants around the stoma in a manner similar to the

system used for breast cancer patients to facilitate topographical description of

the lesions

7,5 cm 7,5 cm

Classification

• L1 Hyperemic lesion (peristomal skin reddening without loss of substance)

• L2 Erosive lesion with loss of substance NOT extending beyond the dermis

• L3 Ulcerative lesion extending beyond the dermis

• L4 Ulcerative fibrinous/necrotic lesion

• LX Proliferative lesions (granulomas, oxalate deposits, neoplasm)

Topography

• TI = Upper left

• TII = Upper right

• TIII = Lower right

• TIV = Lower left

• TV = Total

Ruler

Brochure

Once it was ascertained that the classification system was a helpful tool, a pocket ruler guide for the classification was created to provide a brief summary and practical explanation on the classification system to be used by ET nurses in daily work.

Peristomal

Skin

Integrity

SACS Classification:

L1: Hyperemic lesion

TV: total


L2: Erosive lesion with loss of substance not extending beyond the

dermis

TV: total


L3: Ulcerative lesion extending beyond the

dermis

TIII-IV: lower right and lower left


L4: Ulcerative fibrinous/necrotic lesion

TIII-IV: Lower right and lower left


LX: Proliferative lesions (granulomas, oxalate deposits, neoplasm)

TV: total

“Improving and maintaining the integrity of peristomal skin is an important objective for

both ostomy patients and ostomy care professionals.

Peristomal skin integrity plays a fundamental role in the improvement of quality of life of

a patient with an abdominal ostomy.”

A.I.O.S.S. (Italian Association of Enterostomal Therapist)

THANK YOU TO:

CONVATEC ITALY

THANK YOU FOR YOUR ATTENTION!

The collegues of the study

Multicenter observational study on peristomal skin disorders

Health & Medicine

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