Andersen NK, Trøjgaard P, Herschend NO, Størling ZM. Automated assessment of peristomal skin discoloration and leakage area using artificial intelligence. Frontiers in Artificial Intelligence. 2020; 3

Fellows J, Voegeli D, Håkan-Bloch J, Herschend NO, Størling Z. Multinational survey on living with an ostomy: Prevalence and impact of peristomal skin complications. Br J Nurs. 2021; 30:(16)S22-S30

Jemec GB, Martins L, Claessens I Assessing peristomal skin changes in ostomy patients: Validation of the ostomy skin tool. Br J Dermatol. 2011; 164:(2)330-335

Letourneau S, Jensen L. Impact of a decision tree on chronic wound care. J Wound Ostomy Continence Nurs. 1998; 25:(5)240-247

Li H, Wu TT, Yang DL Decision tree model for predicting in-hospital cardiac arrest among patients admitted with acute coronary syndrome. Clin Cardiol. 2019; 42:(11)1087-1093

Malik T, Lee MJ, Harikrishnan AB. The incidence of stoma related morbidity—a systematic review of randomised controlled trials. Ann R Coll Surg Engl. 2018; 100:(7)501-508

Martins L, Tavernelli K, Serrano JLC. Introducing a peristomal skin assessment tool. World Council of Enterostomal Therapists Journal. 2008; 28:S8-S13

Martins L, Ayello EA, Claessens I The ostomy skin tool: tracking peristomal skin changes. Br J Nurs. 2010; 19:(15)960-964

Meisner S, Lehur PA, Moran B, Martins L, Jemec GB. Peristomal skin complications are common, expensive, and difficult to manage: A population based cost modeling study. PLoS One. 2012; 7:(5)

Monks G, Rivera-Oyola R, Lebwohl M. The psoriasis decision tree. Journal of Clinical and Aesthetic Dermatology. 2021; 14:(4)14-22

Parnham A, Copson D, Loban T. Moisture-associated skin damage: Causes and an overview of assessment, classification and management. Br J Nurs. 2020; 29:(12)S30-S37

Persson E, Berndtsson I, Carlsson E, Hallén AM, Lindholm E. Stoma-related complications and stoma size–a 2-year follow up. Colorectal Dis. 2010; 12:(10)971-976

Shabbir J, Britton DC. Stoma complications: A literature overview. Colorectal Dis. 2010; 12:(10)958-964

The Ostomy Skin Tool 2.0: a new instrument for assessing peristomal skin changes

21 April 2022
16 min read
Volume 31 · Issue 8



Peristomal skin complications (PSCs) are frequently reported postoperative complications. PSCs can present visibly or as symptoms such as pain, itching or burning sensations.


To develop a new tool that can capture a range of sensation symptoms together with visible complications and an objective assessment of discolouration in the peristomal area.


Consensus from qualitative interviews with health professionals and people with an ostomy, and input from expert panels, formed the basis of a patient-reported outcome (PRO) questionnaire. A decision tree model was used to define a combined score including PRO and objectively assessed discolouration area.


Six elements were included in the PRO questionnaire and four health states representing different severity levels of the peristomal skin were defined.


The Ostomy Skin Tool 2.0 is a sensitive tool that can be used to follow changes in the peristomal skin on a regular basis and thereby help prevent severe PSCs.

Creation of an ostomy in the abdominal area is a commonly performed general surgical practice. The consequence, however, can be life-changing for the patient and, despite careful pre-operative planning, postoperative complications are likely to occur (Shabbir and Britton, 2010; Malik et al, 2018). Peristomal skin complications (PSCs) are some of the most frequently reported complications and the latest evidence has shown that up to 88% of people with an ostomy suffer from PSCs (Fellows et al, 2021). The Ostomy Skin Tool (OST) was developed in 2008 and validated as a standardised instrument for assessing both the extent and severity of changes in the peristomal skin condition of people living with an ostomy (Martins et al, 2008; Jemec et al, 2011). The OST is primarily based on clinician-reported outcomes and used to document the visual signs of the peristomal skin. Specifically, this tool focuses on changes in three domains: discolouration (D), erosion (E), and tissue overgrowth (T), summarised in a DET score (Martins et al, 2010). The three domains are scored according to the percentage of area under the adhesive that is impacted and the severity of the symptoms such as bleeding, itching, pain, burning and moisture. The composite DET score is defined on a scale from 0 to 15, and subjects are subsequently assigned to one of the four severity categories: ‘normal skin’ (DET=0), ‘mild’ (DET=2-3), ‘moderate’ (DET=4-6), or ‘severe’ (DET=7-15) (Jemec et al, 2011). Thus, the OST has been used for many years as a validated instrument for health professionals to perform standardised evaluation and treatment of PSCs.

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