S.A.C.S. Evolution: a dual-interface assessment system to evaluate peristomal skin condition and prevent skin lesion

BACKGROUND: Peristomal skin complications represent one of the main clinical concerns in people with an ostomy. Existing assessment tools do not include preventive approaches and active participation of the patient. S.A.C.S. Evolution was created to fill this gap, introducing the concept of healthy peristomal skin (L0) as a primary clinical reference and developing a dual interface dedicated to the healthcare professional and the patient. METHODS: A prospective multicenter observational study validated the psychometric properties of S.A.C.S. Evolution: Phase one tested face validity, phase two tested content validity and phase three evaluated criterion and predictive validity with the longitudinal application on patients with intestinal or urinary ostomy, followed at 1, 3, and 6 months. RESULTS: Face validity reached unanimous consensus among both healthcare professionals and patients. Content validity showed a Content Validity Index > 0.96 among professionals and 1.00 among patients. Criterion validity showed a 95.5% agreement between S.A.C.S. Evolution and S.A.C.S. 2.0 assessments, and a high overlap between patient and stoma nurse evaluations. Longitudinal analysis showed a significant reduction in lesion severity over time, with an increase in the marginal probability of maintaining a healthy skin state (L0) above 90% at six months. Age was confirmed as a predictive factor of greater severity. CONCLUSIONS: S.A.C.S. Evolution proved valid, reliable, and clinically sensitive in the assessment of peristomal skin condition and consequent prevention of peristomal alterations. Its dual interface, clear terminology, and focus on healthy peristomal skin support early prevention, patient empowerment, and standardization of stoma care pathways. Digital integration could further enhance its impact.