title: Use of Munsell color charts to measure skin tone objectively in nursing home residents at risk for pressure ulcer development.
abstract: OBJECTIVE
  To assess the feasibility of classifying skin tone using Munsell color chart values and to compare Munsell-based skin tone categories to ethnicity/race to predict pressure ulcer risk.
  
  
  BACKGROUND
  Pressure ulcer classification uses level of visible tissue damage, including skin discoloration over bony prominences. Prevention begins with early detection of damage. Skin discoloration in those with dark skin tones can be difficult to observe, hindering early detection.
  
  
  METHODS
  Observational cohort of 417 nursing home residents from 19 nursing homes collected between 2009-2014, with weekly skin assessments for up to 16 weeks.
  
  
  METHODS
  Assessment included forearm and buttocks skin tone based on Munsell values (Dark, Medium, Light) at three time points, ethnicity/race medical record documentation, and weekly skin assessment on trunk and heels.
  
  
  RESULTS
  Inter-rater reliability was high for forearm and buttock values and skin tone. Mean Munsell buttocks values differed significantly by ethnicity/race. Across ethnicity/race, Munsell value ranges overlapped, with the greatest range among African Americans. Trunk pressure ulcer incidence varied by skin tone, regardless of ethnicity/race. In multinomial regression, skin tone was more predictive of skin damage than ethnicity/race for trunk locations but ethnicity/race was more predictive for heels.
  
  
  CONCLUSIONS
  Given the overlap of Munsell values across ethnicity/race, color charts provide more objective measurement of skin tone than demographic categories. An objective measure of skin tone can improve pressure ulcer risk assessment among patients for whom current clinical guidelines are less effective.
authors.affiliation: Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Heather E
authors.initials: HE
authors.lastname: McCreath
authors.affiliation: School of Nursing and Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Bates-Jensen
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, University of Tokyo, Japan.
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.affiliation: School of Nursing, University of California, Los Angeles, California, USA.
authors.forename: Anabel
authors.initials: A
authors.lastname: Patlan
authors.affiliation: University of California, Los Angeles, California, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Booth
authors.affiliation: University of California, Los Angeles, California, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Connolly
authors.affiliation: University of California, Los Angeles, California, USA.
authors.forename: Cyndi
authors.initials: C
authors.lastname: Truong
authors.affiliation: University of California, Los Angeles, California, USA.
authors.forename: Agazi
authors.initials: A
authors.lastname: Woldai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003116:Color; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000517:prevention & control*; D018570:Risk Assessment; D012880:Skin Pigmentation; D014481:United States
keywords: ethnicity; gerontology; nurse pressure ulcer detection; nursing home care; nursing skin assessment; pressure ulcers