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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
“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
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
“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.”
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
“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.”
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
“A study group comprised of seven enterostomal therapy nurses and four
surgeons sought to provide an objective, reproducible, standardized classification
instrument.”
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
Ambulatorio Stomaterapia
Ospedale “San Giovanni
Battista”
Le Molinette – Torino\
Ambulatorio Stomaterapia
Ospedale “San Giuseppe” –
Azienda U.S.L. 11 Empoli
Ambulatorio Stomaterapia
Azienda Ospedaliera
“Garibaldi” - Catania
Presidio Ospedaliero “San
Luigi Curro” - Catania
Ospedale “Piemonte” - Messina
Ambulatorio Stomaterapia
Azienda Ospedaliera “San
Maurizio” - Bolzano
Ambulatorio Stomaterapia
Ospedale “Misericordia e
Dolce” – Azienda U.S.L. 4
Prato
Ambulatorio Stomaterapia
Policlinico Universitario
“Campus Biomedico” - Roma
Ostomy Centers across Italy
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
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:
A Proposal of Classification
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
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
A prospective, observational study was conducted between December 2003 and February 2006.
Patient Demographic Group 1
<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%
Patient Demographic Group 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”.
Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
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
SACS Classification:
L2: Erosive lesion with loss of substance not extending beyond the
dermis
TV: total
SACS Classification:
L3: Ulcerative lesion extending beyond the
dermis
TIII-IV: lower right and lower left
SACS Classification:
L4: Ulcerative fibrinous/necrotic lesion
TIII-IV: Lower right and lower left
SACS Classification:
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