To Örebro University

BACKGROUND: Incontinence-associated dermatitis (IAD) is a prevalent and distressing form of irritant contact dermatitis caused by prolonged exposure to urine and/or faeces. Not all incontinent individuals develop IAD, suggesting that additional prognostic factors contribute to its onset. The quality of empirical evidence supporting risk factors for IAD development is moderate to very low. Therefore, it is necessary to systematically compile and analyse expert knowledge on this topic.

AIM: This study aimed to identify and prioritise key prognostic factors for IAD development through an international expert consultation.

MATERIALS AND METHODS: A cross-sectional expert survey was conducted among international experts using an electronic survey platform. Participants rated the importance of 26 pre-identified prognostic factors, ranked relevant factors and suggested additional factors. Data were analysed to determine expert consensus and factor rankings.

RESULTS: A total of 45 experts participated, with a response rate of 39 %. The highest-ranked prognostic factors included double incontinence, faecal incontinence, loose stools, stool frequency, urinary incontinence, and impaired mobility. Other important factors were advanced age, friction and shear forces, cognitive impairment, and poor nutrition. In addition, experts highlighted systemic factors such as caregiver knowledge gaps and staff shortages as potential contributors to IAD risk.

CONCLUSION: Study results support established risk factors for IAD development such as stool frequency and limited mobility. Experts also identified factors, such as higher age and the presence of loose or liquid stool, that are considered relevant by experts but are not yet fully supported by empirical evidence. Findings will inform a future large-scale cohort study.

Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.

INTRODUCTION: Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research.

METHODS AND ANALYSIS: This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance.

ETHICS AND DISSEMINATION: No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.