{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:55Z","timestamp":1792787275469,"version":"4.5.0"},"reference-count":40,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Alfred Care Group Scholarship","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"https:\/\/ror.org\/01wddqe20","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,17]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Oral mucosal membrane pressure injuries (MMPIs) and herpes simplex virus type 1 (HSV-1)-related oral mucosal lesions can present with overlapping risk factors and clinical features in intubated people in intensive care units (ICUs), making differentiation challenging. Misclassification may lead to inappropriate management, delayed healing, missed infection-prevention measures and increased healthcare costs. These consequences differ depending on the direction of misclassification. International pressure injury guidelines do not recommend routine HSV testing for suspected MMPIs and standardised diagnostic pathways are lacking. This protocol outlines a planned scoping review to map the nature, extent and types of diagnostic challenges encountered when distinguishing oral MMPIs from HSV-1-related oral mucosal lesions in intubated people in the ICU, and to summarise available evidence on the incidence, characteristics, assessment and terminology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This scoping review protocol follows the Joanna Briggs Institute scoping review methodology using a Population-Concept-Context framework, which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Core Collection and Scopus databases will be searched. Grey literature and unpublished sources will also be searched. Data will be extracted using a standardised tool, and the results will be presented using descriptive tables, and visual and narrative summaries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      Ethical approval is not required as the review uses publicly available literature and does not involve data collection or direct human interaction. The results of the completed review will be disseminated through peer-reviewed publications and conference presentations. This protocol has been registered on the Open Science Framework (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/nrkm5\/overview\">https:\/\/osf.io\/nrkm5\/overview<\/jats:ext-link>\n                      ). Registration DOI:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/82JF9\">10.17605\/OSF.IO\/82JF9<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-123374","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:36:47Z","timestamp":1790775407000},"page":"e123374","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic challenges in distinguishing oral mucosal membrane pressure injuries from HSV-1-related oral mucosal lesions in intubated people in intensive care units: a scoping review protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2236-1731","authenticated-orcid":false,"given":"Hermione","family":"Shea","sequence":"first","affiliation":[{"name":"Monash University - Clayton Campus, Clayton, Victoria, Australia"},{"name":"Alfred Care Group, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3822-0554","authenticated-orcid":false,"given":"Philip","family":"Russo","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Cabrini Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9603-1570","authenticated-orcid":false,"given":"Sebastian","family":"Probst","sequence":"additional","affiliation":[{"name":"Monash University - Clayton Campus, Clayton, Victoria, Australia"},{"name":"HES-SO Gen\u00e8ve, Gen\u00e8ve, Switzerland"},{"name":"University of Geneva, Geneva, Switzerland"},{"name":"University of Galway, Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6372-8048","authenticated-orcid":false,"given":"Johannes S","family":"Kern","sequence":"additional","affiliation":[{"name":"Monash University - Clayton Campus, Clayton, Victoria, Australia"},{"name":"Alfred Care Group, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1173-411X","authenticated-orcid":false,"given":"Olivia","family":"Cook","sequence":"additional","affiliation":[{"name":"Monash University - Clayton Campus, Clayton, Victoria, Australia"},{"name":"Alfred Care Group, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093006351678000_16.9.e123374.1","doi-asserted-by":"crossref","DOI":"10.2196\/11101","article-title":"Endotracheal Intubation Among the Critically Ill: Protocol for a Multicenter, Observational, Prospective Study","volume":"7","author":"Smischney","year":"2018","journal-title":"JMIR Res Protoc"},{"key":"2026093006351678000_16.9.e123374.2","doi-asserted-by":"crossref","first-page":"104355","DOI":"10.1016\/j.iccn.2026.104355","article-title":"Incidence and prevalence of mouth mucosal pressure injury in patients receiving oral endotracheal intubation in the ICU: A systematic review and meta-analysis","volume":"94","author":"Liu","year":"2026","journal-title":"Intensive Crit Care Nurs"},{"key":"2026093006351678000_16.9.e123374.3","doi-asserted-by":"crossref","first-page":"103560","DOI":"10.1016\/j.iccn.2023.103560","article-title":"Mucosal membrane pressure injury in intensive care units: A scoping review","volume":"80","author":"Chen","year":"2024","journal-title":"Intensive Crit Care Nurs"},{"key":"2026093006351678000_16.9.e123374.4","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jtv.2020.06.002","article-title":"Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study","volume":"29","author":"Choi","year":"2020","journal-title":"J Tissue Viability"},{"key":"2026093006351678000_16.9.e123374.5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jtv.2018.11.002","article-title":"Oral mucosa pressure ulcers in intensive care unit patients: A preliminary observational study of incidence and risk factors","volume":"28","author":"Kim","year":"2019","journal-title":"J Tissue Viability"},{"key":"2026093006351678000_16.9.e123374.6","doi-asserted-by":"crossref","DOI":"10.1111\/nicc.70090","article-title":"Characteristics and Risk Factors of Oral Endotracheal Tube-Related Mucous Membrane Pressure Injury in Intensive Care Units","volume":"30","author":"Yi","year":"2025","journal-title":"Nurs Crit Care"},{"key":"2026093006351678000_16.9.e123374.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2015.02.013"},{"key":"2026093006351678000_16.9.e123374.8","unstructured":"European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance . 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