Identification of Skin Injuries in Patients With Dark Skin Tones Using a Modified Robinson-Ho Skin Type Color Bar: A Pilot Study

OBJECTIVE: The aims of this pilot study were to determine whether (1) a modified version of the Robinson-Ho Skin Type Color Bar would identify early, subtle skin tone variations in patients with dark skin tones because of injury, and (2) if the tool was reliable between clinicians. METHODS: This was a prospective, observational cohort study in a surgical intensive care/acute care unit located in an urban, academic hospital. Patients who were ≥18 years old without a skin injury, but with a confirmed dark skin tone based on the modified Robinson-Ho Skin Type Color Bar, were included in the pilot study. RESULTS: The first aim could not be supported because of the lack of patients who developed subtle skin tone changes indicative of a skin injury. Two patients developed a skin injury (deep tissue pressure injury, trauma). These wounds did not manifest as subtle changes, therefore rendering the tool ineffective for these cases. The second aim was supported as inter-rater reliability of the Robinson-Ho Skin Type Color Bar showed moderate agreement between multiple raters. It was also noted that race/ethnicity was not an objective marker for determining skin tone per the tool. CONCLUSIONS: Although the modified Robinson-Ho Skin Type Color Bar was not an effective method to detect subtle skin tone changes indicative of injury because of the 2 wounds that did occur, it was reliable to use between multiple users. The tool also served as an objective marker for determining baseline skin tone.