Skin Failure Clinical Characteristics and Clinical Instruments for Diagnosis in Adult Patients With Advanced or Terminal Diseases: A Scoping Review

Background. There is limited use of the term skin failure in the clinical setting; however, it is valid to question the differences between skin failure and other injuries (eg, pressure injuries). The evaluation of skin failure should be based on specific clinical characteristics to strengthen the knowledge of this phenomenon and to set standards of care. Objective. To evaluate the available evidence about characteristics of and clinical instruments for skin failure diagnosis and evaluation in adult patients with advanced or end-stage disease. Methods. Between April 4 and May 18 2023, a scoping review was conducted and included literature on skin failure classification and diagnosis in patients aged 18 years or older in any health context. Articles that included a pediatric population or dermatologic diagnoses not related to the current concept of skin failure and articles referring only to a theoretical definition of skin failure were excluded. The databases searched were PubMed, CINAHL, Web of Science, LILACS, ScienceDirect, and the Cochrane Database of Systematic Reviews. Grey literature was retrieved via the “DART E-theses Portal” and “CAPES Thesis Portal.” Results. A total of 196 articles were identified. The final sample included 8 studies related to the theoretical concept of skin failure. The most cited factors related to acute skin failure were sepsis, hypoperfusion, vasopressor use, oxygenation, nutritional status, acute organ compromise, mechanical ventilation, and chronic diseases. One specific tool was identified to assess skin failure that included the same characteristics revealed by this scoping review. Conclusion. There is limited evidence regarding clinical indicators for the evaluation of skin failure. The results of this exploratory review suggest specific clinical features of skin failure which may consider other elements than those related to pressure injuries. Primary studies are needed to strengthen the diagnosis of skin failure and its inclusion in routine health care practice at any stage of disease.