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Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs
Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs
Background. Many classification systems for grading pressure ulcers are discussed in
the literature. Correct identification and classification of a pressure ulcer is important
for accurate reporting of the magnitude of the problem, and for timely prevention.
The reliability of pressure ulcer classification systems has rarely been tested.
Aims and objectives. The purpose of this paper is to examine the inter-rater reliability
of classifying pressure ulcers according to the European Pressure Ulcer Advisory
Panel classification system when using pressure ulcer photographs.
Design. Survey was among pressure ulcer experts.
Methods. Fifty-six photographs were presented to 44 pressure ulcer experts. The
experts classified the lesions as normal skin, blanchable erythema, pressure ulcer
(four grades) or incontinence lesion. Inter-rater reliability was calculated.
Results. The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001).
Various groups of experts obtained comparable results. Differences in classifications
are mainly limited to 1 degree of difference. Incontinence lesions are most often
confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure
ulcers).
Conclusions. The inter-rater reliability of the European Pressure Ulcer Advisory
Panel classification appears to be good for the assessment of photographs by experts.
The difference between an incontinence lesion and a blister or a superficial pressure
ulcer does not always seem clear.
Relevance to clinical practice. The ability to determine correctlywhether a lesion is a
pressure ulcer lesion is important to assess the effectiveness of preventive measures. In
addition, the ability to make a correct distinction between pressure ulcers and
incontinence lesions is important as they require different preventive measures. A
faulty classification leads to mistaken measures and negative results. Photographs can
be used as a practice instrument to learn to discern pressure ulcers from incontinence
lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer
Classification software package has been developed to facilitate learning.
0962-1067
952-959
Defloor, T.
4ca437de-5cb1-4d24-91d7-a388ee5839f2
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Defloor, T.
4ca437de-5cb1-4d24-91d7-a388ee5839f2
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de

Defloor, T. and Schoonhoven, Lisette (2004) Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs. Journal of Clinical Nursing, 13 (8), 952-959. (doi:10.1111/j.1365-2702.2004.00974.x). (PMID:15533101)

Record type: Article

Abstract

Background. Many classification systems for grading pressure ulcers are discussed in
the literature. Correct identification and classification of a pressure ulcer is important
for accurate reporting of the magnitude of the problem, and for timely prevention.
The reliability of pressure ulcer classification systems has rarely been tested.
Aims and objectives. The purpose of this paper is to examine the inter-rater reliability
of classifying pressure ulcers according to the European Pressure Ulcer Advisory
Panel classification system when using pressure ulcer photographs.
Design. Survey was among pressure ulcer experts.
Methods. Fifty-six photographs were presented to 44 pressure ulcer experts. The
experts classified the lesions as normal skin, blanchable erythema, pressure ulcer
(four grades) or incontinence lesion. Inter-rater reliability was calculated.
Results. The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001).
Various groups of experts obtained comparable results. Differences in classifications
are mainly limited to 1 degree of difference. Incontinence lesions are most often
confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure
ulcers).
Conclusions. The inter-rater reliability of the European Pressure Ulcer Advisory
Panel classification appears to be good for the assessment of photographs by experts.
The difference between an incontinence lesion and a blister or a superficial pressure
ulcer does not always seem clear.
Relevance to clinical practice. The ability to determine correctlywhether a lesion is a
pressure ulcer lesion is important to assess the effectiveness of preventive measures. In
addition, the ability to make a correct distinction between pressure ulcers and
incontinence lesions is important as they require different preventive measures. A
faulty classification leads to mistaken measures and negative results. Photographs can
be used as a practice instrument to learn to discern pressure ulcers from incontinence
lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer
Classification software package has been developed to facilitate learning.

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Published date: November 2004
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339752
URI: http://eprints.soton.ac.uk/id/eprint/339752
ISSN: 0962-1067
PURE UUID: 35a29682-391f-4277-9b52-69e136b68997
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 30 May 2012 10:40
Last modified: 07 Oct 2020 05:54

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