Skin Assessment Strategies for Identification of Pressure Injuries in Dark-Skin-Tone Patients: A Scoping Review

Abstract

Background: Early pressure injury detection is essential in acute care, yet diagnostic inequities persist for individuals with dark skin tones. Traditional visual assessment relies on colour changes that may not be visible in richly pigmented skin, contributing to delayed diagnosis and poorer outcomes. Objective: Our aim was to identify and map strategies reported in the literature for assessing skin and underlying tissue to support early pressure injury detection in adults with dark skin tones in acute care settings. Methods: A scoping review was conducted following Joanna Briggs Institute methodology and reported according to PRISMA-ScR. Searches were performed in CINAHL, PubMed, Scopus, Web of Science, and Google Scholar (April 2025; updated February 2026). Primary research published in English since 2017 was eligible. After screening and data extraction, descriptive thematic analysis was applied to identify recurrent strategies reported in the literature for assessment of skin and underlying tissues for detection of pressure injury. No appraisal of the included sources was conducted. Results: Ten studies met the inclusion criteria. Strategies identified for detecting pressure injuries were mainly for implementation across diverse skin tones, but all included aspects of dark-skin-tone participants. These approaches are clustered into four categories: thermographic imaging, subepidermal moisture sensors, image processing and colorimetry, and enhanced assessment and lighting techniques. The evidence highlights the growing value of objective, technology-supported methods for improving detection in people with dark skin tones. Routine bedside visual and tactile assessment was notably underrepresented, indicating a clear evidence gap. Overall, the review emphasises the need to integrate objective technologies into everyday practice to support more equitable pressure injury detection. Conclusions: This scoping review highlighted that evidence for routine visual and tactile assessment in dark skin tones remains limited. Technology-supported assessment approaches show promise for improving diagnostic equity in pressure injury detection. Identification of strategies used to perform skin assessment for pressure injury identification is critical to the wellbeing of persons with dark skin tones. This review demonstrates that while emerging technologies offer promising ways to improve pressure injury detection across diverse skin tones, evidence supporting everyday bedside visual and tactile assessment for individuals with dark skin tones remains notably limited. Strengthening this evidence base and integrating objective technologies into routine care are essential steps toward more accurate and equitable pressure injury detection.