SORA-SF Clinical Assessment Tool

Skin Failure Etiology, Stop-Gap Verification & Domain Scoring Framework

Composite Domain Score
0 / 24
UNCLEAR / LOW CONFIDENCE
STOP-GAP SOC: NOT MET
Assessment Progress 0% Complete

Section 1: Introduction & Educational Framework

Clinical Purpose & Usage Guidelines

1. Skin Failure occurs when skin and underlying tissue atrophy/die due to "hypoperfusion" or inadequate blood flow during critical illness, chronic disease progression, or the dying process. Unlike pressure injuries caused by external mechanical forces, skin failure results from internal vascular compromise affecting tissue perfusion.

2. This tool utilizes an initial standard-of-care verification (stop-gap) to reduce false-positive skin failure diagnoses, followed by a multi-domain scoring system that layers clinical context, laboratory evidence, wound characteristics, and end-of-life indicators to guide differential diagnosis.

3. This tool serves to guide clinicians in determining a differential for wound etiology, adapted from Hill/Peterson, Latimer, PAWSIC, and clinical practice. It does not replace a provider's clinical judgment or final determination.

4. Use when new skin/tissue impairment is identified in a patient with known/suspected critical illness, multi-organ dysfunction, chronic decompensation, or clinical decline suggesting end of life.

5. Recommendation: Full reassessment using SORA-SF every 2 weeks or sooner if clinical status changes significantly.

Section 2: STOP Gap Verification (Standard of Care)

Stop-gap reduces risk for false positives or over-use of skin failure as primary diagnosis. Verify documented prevention measures implemented within 72 hours PRIOR to wound onset at least Q-shift. Hover over options for clinical guidelines. Items 1, 2, 4, 5, and 6 are mandatory to pass.

Braden score with risk-based interventions (including associated care plan per site policy)
Documented q2h or individualized turning schedule adhered to
Dietician/nutritionist consult and/or note written, or supplementation noted in MAR
Pressure redistribution, bariatrics with air, low airloss, fluidized/air-immersion
Offloading devices (boots, wedge depending on location)
External urine isolation devices, emollient use, skin barrier per protocol

Section 3: Domain Scoring (0–24 Points Across 4 Domains)

Domain 1a: Clinical Context — Body Systems

Select affected body systems. Specific disease examples are listed underneath each option for reference.

Acute System Dysfunction
e.g., Acute cardiogenic shock, cardiac arrest, malignant dysrhythmias, pressor dependency, sustained MAP < 60
e.g., ARDS, acute respiratory failure requiring mechanical ventilation, severe acute hypoxia
e.g., Acute Kidney Injury (AKI Stage 2/3), acute anuria, emergent CRRT/dialysis
e.g., Acute fulminant liver failure, ischemic bowel, severe acute GI hemorrhage, acute pancreatitis
e.g., Acute brain injury, acute stroke with multi-organ impact, severe encephalopathy, obtundation
e.g., Septic shock, DIC, active severe coagulopathy, MODS, severe acute anemia with transfusion
Chronic System Disease
e.g., Decompensated severe HF (NYHA Class IV), severe CAD, severe peripheral artery disease (PAD)
e.g., End-stage COPD, severe pulmonary fibrosis, chronic oxygen dependency
e.g., End-Stage Renal Disease (ESRD) on chronic hemodialysis / peritoneal dialysis
e.g., Decompensated Cirrhosis with ascites/encephalopathy (Child-Pugh C), chronic intestinal failure
e.g., Advanced dementia, ALS, severe quadriplegia, chronic neurodegenerative decline
e.g., Active metastatic malignancy, end-stage autoimmune disease, severe chronic refractory anemia

Domain 1b: Provider Documentation

Domain 2a: Hypoperfusion Lab Markers

Domain 2b: Hemodynamic Status

Domain 3a: Wound Characteristics — Location/Distribution

Domain 3b: Wound Characteristics — Appearance/Morphology

Domain 3c: Wound Characteristics — Onset/Progression

Domain 4a: Physiological Decline

Domain 4b: Goals of Care (GOC) Status

Domain 4c: Observed Skin Failure Patterns (Non-Scored)

Section 4: Skin Failure Classification Decision Tree

Trajectory C Status: Evaluating assessment data...

Classification Pending Assessment...

Complete Section 3 scoring to execute the clinical decision tree.

Provider Documentation