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EPUAP classification system for pressure ulcers: European reliability study

EPUAP classification system for pressure ulcers: European reliability study
EPUAP classification system for pressure ulcers: European reliability study
EPUAP classification system for pressure ulcers: European reliability study
Aim. This paper is a report of a study of the inter-observer reliability of the
European Pressure Ulcer Advisory Panel pressure ulcer classification system and of
the differential diagnosis between moisture lesions and pressure ulcers.
Background. Pressure ulcer classification is a valuable tool to provide a common
description of ulcer severity for the purposes of clinical practice, audit and research.
Despite everyday use of the European Pressure Ulcer Advisory Panel system, its
reliability has been evaluated in only a limited number of studies.
Methods. Asurvey was carried out between September 2005 and February 2006 with
a convenience sample of 1452 nurses from five European countries. Respondents
classified 20 validated photographs as normal skin, blanchable erythema, pressure
ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar
with the use of the European Pressure Ulcer Advisory Panel classification scale.
Results. Pressure ulcers were often classified erroneously (j = 0Æ33) and only a
minority of nurses reached a substantial level of agreement. Grade 3 lesions were
regularly classified as grade 2. Non-blanchable erythema was frequently assessed
incorrectly as blanchable erythema. Furthermore, the differential diagnosis between
moisture lesions and pressure ulcers appeared to be complicated.
Conclusion. Inter-observer reliability of the European Pressure Ulcer Advisory Panel
classification system was low. Evaluation thus needs to focus on both the clarity and
complexity of the system. Definitions and unambiguous descriptions of pressure ulcer
grades and the distinction between moisture lesions will probably enhance clarity. To
simplify the current classification system, a reduction in the number of grades is
suggested.
0309-2402
682-691
Beeckman, D.
b511e754-d654-4151-b3cb-65e92965207d
Schoonhoven, L.
46a2705b-c657-409b-b9da-329d5b1b02de
Fletcher, J.
b7ccf16a-7ab1-45a0-bf67-64fd6aa497dc
Furtado, K.
6a7e64d6-a703-44d6-92bd-0770ac503bac
Gunningberg, L.
20911a4b-2b75-4848-856b-a365c22120b5
Heyman, H.
6e92b349-cbbf-4a8c-af63-6895a467f9f1
Lindholm, C.
6de60f6e-0d32-4bc1-a7d1-0b2c78bb6acf
Paquay, L.
7c23ba60-ebf7-4069-a531-d25afbab0535
Verdu, J.
84f8917c-5ced-44e8-a40b-090aeb43c91f
Defloor, T.
4ca437de-5cb1-4d24-91d7-a388ee5839f2
Beeckman, D.
b511e754-d654-4151-b3cb-65e92965207d
Schoonhoven, L.
46a2705b-c657-409b-b9da-329d5b1b02de
Fletcher, J.
b7ccf16a-7ab1-45a0-bf67-64fd6aa497dc
Furtado, K.
6a7e64d6-a703-44d6-92bd-0770ac503bac
Gunningberg, L.
20911a4b-2b75-4848-856b-a365c22120b5
Heyman, H.
6e92b349-cbbf-4a8c-af63-6895a467f9f1
Lindholm, C.
6de60f6e-0d32-4bc1-a7d1-0b2c78bb6acf
Paquay, L.
7c23ba60-ebf7-4069-a531-d25afbab0535
Verdu, J.
84f8917c-5ced-44e8-a40b-090aeb43c91f
Defloor, T.
4ca437de-5cb1-4d24-91d7-a388ee5839f2

Beeckman, D., Schoonhoven, L., Fletcher, J., Furtado, K., Gunningberg, L., Heyman, H., Lindholm, C., Paquay, L., Verdu, J. and Defloor, T. (2007) EPUAP classification system for pressure ulcers: European reliability study. Journal of Advanced Nursing, 60 (6), 682-691. (doi:10.1111/j.1365-2648.2007.04474.x).

Record type: Article

Abstract

EPUAP classification system for pressure ulcers: European reliability study
Aim. This paper is a report of a study of the inter-observer reliability of the
European Pressure Ulcer Advisory Panel pressure ulcer classification system and of
the differential diagnosis between moisture lesions and pressure ulcers.
Background. Pressure ulcer classification is a valuable tool to provide a common
description of ulcer severity for the purposes of clinical practice, audit and research.
Despite everyday use of the European Pressure Ulcer Advisory Panel system, its
reliability has been evaluated in only a limited number of studies.
Methods. Asurvey was carried out between September 2005 and February 2006 with
a convenience sample of 1452 nurses from five European countries. Respondents
classified 20 validated photographs as normal skin, blanchable erythema, pressure
ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar
with the use of the European Pressure Ulcer Advisory Panel classification scale.
Results. Pressure ulcers were often classified erroneously (j = 0Æ33) and only a
minority of nurses reached a substantial level of agreement. Grade 3 lesions were
regularly classified as grade 2. Non-blanchable erythema was frequently assessed
incorrectly as blanchable erythema. Furthermore, the differential diagnosis between
moisture lesions and pressure ulcers appeared to be complicated.
Conclusion. Inter-observer reliability of the European Pressure Ulcer Advisory Panel
classification system was low. Evaluation thus needs to focus on both the clarity and
complexity of the system. Definitions and unambiguous descriptions of pressure ulcer
grades and the distinction between moisture lesions will probably enhance clarity. To
simplify the current classification system, a reduction in the number of grades is
suggested.

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Published date: December 2007
Organisations: Faculty of Health Sciences

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Local EPrints ID: 339721
URI: https://eprints.soton.ac.uk/id/eprint/339721
ISSN: 0309-2402
PURE UUID: 61cef127-629f-43b4-a97c-9d67c9d6f375
ORCID for L. Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 29 May 2012 16:05
Last modified: 17 Jul 2019 00:41

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Contributors

Author: D. Beeckman
Author: L. Schoonhoven ORCID iD
Author: J. Fletcher
Author: K. Furtado
Author: L. Gunningberg
Author: H. Heyman
Author: C. Lindholm
Author: L. Paquay
Author: J. Verdu
Author: T. Defloor

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