Review of the International Skin Tear Advisory Panel (ISTAP) guidance document


Annie Clothier, RGN, Tissue Viability Nurse, Aneurin Bevan Health Board, South Wales

Background reading



Skin tears are described as traumatic wounds that result from a separation in the two principle layers of the skin, the dermis and epidermis. They are caused by shear, friction and/or blunt force [1,2]. Often deemed a common occurrence and more prevalent than pressure ulcers, they are viewed as quality of care indicators particularly in elderly care establishments, and therefore pose a significant problem for healthcare professionals as the number of older people increases [1,3,4,5,6]. However, skin tears can also occur in critically ill patients, neonates and infants [1].

They are often unreported, particularly in the community setting [7]. Where possible, prevention should be the priority, but when they do occur the focus of should remain on accurate assessment and appropriate management to both minimise the chances of further trauma and preserve viable tissue [6].

Until recently this area of wound management was under-appreciated with little research directed towards it [1]. To date, no prevalence or incidence data exists for the UK; available data originates from the United States and Australia. Therefore the financial impact on the NHS is not fully known [1,6].

Classifying skin tears

Skin tears were first defined and classified by Payne and Martin [8] in 1993 which was later adapted by Carville [3] to produce the STAR (Skin Tear Audit Research) tool [1]. In 2011 the All Wales Tissue Viability Nurse Forum produced a Best Practice Statement [9], which is feely available to download and is a useful tool for any practitioner.

Despite such guidance, it was recognised that wide variations in practice occur; in an attempt to address this, the International Skin Tear Advisory Panel (ISTAP) was established. The ISTAP comprises 13 key opinion leaders who met with the aim of providing guidance and a universally accepted and validated classification system in the assessment of skin tears [1]. The resulting tool-kit should be utilised as a basis both for education and the implementation of guidelines for prevention and treatment programmes. It includes:

  • a skin tear risk assessment pathway (Figure 1)
  • the ISTAP Skin Tear Classification (Figure 2)
  • a skin tear decision algorithm (Figure 3)
  • a pathway for assessment and treatment of skin tears
  • a prevalence study data collection sheet
  • a quick reference guide for the ISTAP risk reduction program
  • medications that can affect the skin
  • drugs associated with risk of falls
  • skin tear management product selection guide


The document is very comprehensive and gives the clinician many ways to implement effective skin tear prevention, assessment and treatment practices [1]. Furthermore, the beauty of this tool kit is that it is designed to be used in a variety of healthcare settings and easily utilised by all levels of staff, allowing for a better outcome for the patient. The ISTAP guidance focuses on the importance of a comprehensive assessment of an individual’s risk for skin tears and addressing these in order to prevent occurrence.

 Making clinicians more aware of the guidance that is available to them will go a long way in ensuring patients are protected and clinicians feel confident in dealing with those patients who have fragile skin.

As with pressure ulcers, the development of the European Pressure Ulcer Advisory Panel facilitated best practice and research in this area [10]. It is hoped that the same can be achieved for skin tears with the acceptance of the ISTAP guidance document.

PCNR would like to thank ISTAP for kind permission to reproduce the figures from their document which can be found in full here: