Reliability of the European pressure ulcer advisory panel classification system

Abstract

Aim. This paper reports a study examining the interrater and intrarater reliability of
classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel
classification system when using photographs of pressure ulcers and incontinence
lesions.
Background. Pressure ulcer classification is an essential tool for assessing ulcers and
their severity and determining which preventive or therapeutic action is needed.
Many classification systems are described in the literature. There are only a limited
number of studies that evaluate the interrater reliability of pressure ulcer grading
scales. The intrarater reliability is seldom studied.
Methods. The study consisted of two phases. In the first phase 56 photographs,
together with a random selection of nine photographs from the same set, were presented
to 473 nurses. In the second phase, the 56 photographs were presented twice
to 86 other nurses with an interval of one month and in a different order. All the
nurses were familiar with the European Pressure Ulcer Advisory Panel classification.
They did not receive any additional training on classification, and were asked to
classify the lesions as normal skin, blanchable erythema, pressure ulcers (four grades,
European Pressure Ulcer Advisory Panel classification) or incontinence lesions.Results. In the first phase, the multirater-Kappa for the 473 participating nurses was
0.37 (P < 0.001). Non-blanchable erythema was often confused with blanchable
erythema and incontinence lesions. Also incontinence lesions were frequently not
correctly classified. The intrarater agreement was low (k = 0.38). In the second
phase, the interrater agreement was not significantly different in both sessions. The
intrarater agreement was 0.52.Conclusion. Both the interrater and intrarater reliability of the European Pressure
Ulcer Advisory Panel classification of lesion photographs by nurses was very low.
Differentiation between pressure ulcers and incontinence lesions seems to be difficult

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ORCID for Lisette Schoonhoven: orcid.org/0000-0002-7129-3766

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