TY - JOUR
T1 - Reliability of the European pressure ulcer advisory panel classification system
AU - Defloor, T.
AU - Schoonhoven, Lisette
AU - Katrien, V.
AU - Weststrate, J.
AU - Myny, D.
PY - 2006/4
Y1 - 2006/4
N2 - Aim. This paper reports a study examining the interrater and intrarater reliability ofclassifying pressure ulcers according to the European Pressure Ulcer Advisory Panelclassification system when using photographs of pressure ulcers and incontinencelesions.Background. Pressure ulcer classification is an essential tool for assessing ulcers andtheir severity and determining which preventive or therapeutic action is needed.Many classification systems are described in the literature. There are only a limitednumber of studies that evaluate the interrater reliability of pressure ulcer gradingscales. 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 presentedto 473 nurses. In the second phase, the 56 photographs were presented twiceto 86 other nurses with an interval of one month and in a different order. All thenurses were familiar with the European Pressure Ulcer Advisory Panel classification.They did not receive any additional training on classification, and were asked toclassify 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 was0.37 (P <0.001). Non-blanchable erythema was often confused with blanchableerythema and incontinence lesions. Also incontinence lesions were frequently notcorrectly classified. The intrarater agreement was low (k = 0.38). In the secondphase, the interrater agreement was not significantly different in both sessions. Theintrarater agreement was 0.52.Conclusion. Both the interrater and intrarater reliability of the European PressureUlcer Advisory Panel classification of lesion photographs by nurses was very low.Differentiation between pressure ulcers and incontinence lesions seems to be difficult
AB - Aim. This paper reports a study examining the interrater and intrarater reliability ofclassifying pressure ulcers according to the European Pressure Ulcer Advisory Panelclassification system when using photographs of pressure ulcers and incontinencelesions.Background. Pressure ulcer classification is an essential tool for assessing ulcers andtheir severity and determining which preventive or therapeutic action is needed.Many classification systems are described in the literature. There are only a limitednumber of studies that evaluate the interrater reliability of pressure ulcer gradingscales. 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 presentedto 473 nurses. In the second phase, the 56 photographs were presented twiceto 86 other nurses with an interval of one month and in a different order. All thenurses were familiar with the European Pressure Ulcer Advisory Panel classification.They did not receive any additional training on classification, and were asked toclassify 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 was0.37 (P <0.001). Non-blanchable erythema was often confused with blanchableerythema and incontinence lesions. Also incontinence lesions were frequently notcorrectly classified. The intrarater agreement was low (k = 0.38). In the secondphase, the interrater agreement was not significantly different in both sessions. Theintrarater agreement was 0.52.Conclusion. Both the interrater and intrarater reliability of the European PressureUlcer Advisory Panel classification of lesion photographs by nurses was very low.Differentiation between pressure ulcers and incontinence lesions seems to be difficult
U2 - 10.1111/j.1365-2648.2006.03801.x/abstract
DO - 10.1111/j.1365-2648.2006.03801.x/abstract
M3 - Article
SN - 0309-2402
VL - 54
SP - 189
EP - 198
JO - Journal of Advanced Nursing
JF - Journal of Advanced Nursing
IS - 2
ER -