Will the Real DTI, Please Stand Up?

Deep Tissue Injury (DTI). What, exactly, is it? DTI is typically described as a localized discoloration of intact skin or a blood-filled blister with soft tissue damage from pressure and/or shear.

Deep Tissue Injury (DTI). What, exactly, is it? DTI is typically described as a localized discoloration of intact skin or a blood-filled blister with soft tissue damage from pressure and/or shear. Colors range from maroon to purple and the skin runs the gamut of textures from boggy to firm, mushy to painful, warm to cool. DTIs form in tissue that has been subjected to sustained pressure beyond its tolerance level. Clearly, DTIs are difficult to unequivocally diagnose. But, properly picking them out of a line-up is crucial for effective treatment. They’re just not always evident on admission. 

When evaluating suspected deep tissue injuries, healthcare providers will often compile a differential diagnosis to help rule out separate conditions that may present with similar characteristics. A medical process of elimination. Because DTIs can mimic other issues, asking questions, reviewing medical history and clearly identifying the patient’s condition prior to admission are critical for a proper diagnosis. Deep tissue injuries are tricky. Taking the time to rule out conditions helps guide clinicians closer to the root cause.

Deep tissue injuries can easily be mistaken for Stage I pressure injuries. Both can be firm or soft, warm or cool. And both involve non-blanchable intact skin. The subtle difference may lie in the color. DTIs, in light-skinned patients, are usually darker in appearance than Stage 1 pressure injuries. Detecting DTIs in dark-skinned individuals poses another set of challenges. For these patients, areas of redness or hyperpigmentation compared to surrounding skin may be the tell-tale sign. Pain when palpated is also an indicator of underlying deep tissue injuries. For all patients, however, it takes a keen eye to differentiate between the two. 

But maybe it is just a bruise! Suspected deep tissue injuries are elusive and can resemble bruises. And in all fairness, they do share some common qualities. Both involve non-blanchable, intact skin. And, as far as color goes, they are similar in this area as well — darker maroon or purple. But there is one significant difference, DTIs are caused from pressure and shear not blunt force trauma. Knowing the backstory of patients prior to admission will help differentiate between simple bruises and DTIs. Ask the questions!

Patients at risk for DTI development include critically ill patients with significant restrictions on repositioning, patients with compromised oxygen perfusion or on vasopressors and those with nutritional issues even when severely obese. Like most things, early identification is important. And early identification of a DTI can reverse the trajectory of a full-thickness pressure injury. Full-thickness PIs are complicated and can require intense nursing, medical and surgical treatment. Healing time can be lengthy, and costs are high. Through early detection, offloading and reperfusion, injured tissue can be saved. 
Thorough skin assessments upon admission, including what was happening before the patient entered the facility is critical to really determining how and when a DTI may have started. Ruling out issues like Stage 1 pressure injuries or bruises through a simple process of elimination will help patients receive the proper treatment. Fast! Click here to explore solutions for deep tissue injury and pressure injury prevention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950046/#:~:text=Locations%20of%20deep%20tissue%20injury,stable%20eschar%20on%20the%20heel.

NPUAP] www.npuap.org/…/DTI-White-Pa…National Pressure Ulcer Advisory Panel

Deep Tissue Injury. Overview.

Deep Tissue Injury and Differential Diagnosis, C. Tod Brindle, MSN, RN, ET, CWOCN  Medical Director Wound Care VCU Medical Center

What is a Deep Tissue Injury? August 6, 2013 by Laurie Swezey  Wound Educators.com  

National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System Joyce Black, PhD, RN, CWCN, CPSN, Mona Baharestani, PhD, ANP, CWOCN, CWS, FAPWCA, FCCWS, Janet Cuddigan, PhD, RN, CWCN, CCCN, Becky Dorner, RD, LD, Laura Edsberg, PhD, Diane Langemo, PhD, RN, FAAN, Mary Ellen Posthauer, RN, CD, LD, Catherine Ratliff, PhD, APRN-BC, CWOCN, George Taler, MD  Disclosures  Urol Nurs. 2007;27(2):144-150.

Cathy Thomas Hess. Did You Know ? The Difference between Friction and Shear. Advances in Skin and Wound Care: June 2004, volume 17:5. p.222)   

www.woundsource.com/…/pressure-ulcers-suspected-deep-tissue-injury-s…A comprehensive article discussing the etiology, risk factors, complications, diagnosis and treatment of deep tissue injuries. Accessed 2-16-2015