Reliability of pressure ulcer classification and diagnosis

Abstract

Overall agreement and Kappa statistics indicated 'very good' and 'good' agreement between expert nurses, and between expert nurses and qualified ward-based staff, respectively. However, the high prevalence of normal skin concealed clinically important disagreements in both the diagnosis of pressure ulcers and skin classification for all grades.

Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers: PRESSURE (pressure relieving support surfaces) trial

“…We took steps to minimise the potential for bias this allows by collecting independent skin assessments carried out by both the ward staff and the clinical research nurses. 3 Although ward nurses were not blind to allocation, we have no evidence that this influenced the care given. The frequent mattress changes were a strength of this trial as they represent the use of mattresses in real life and provide generalisable data.…”

“…The target population was participants aged at least 55 years who had been admitted to vascular, orthopaedic, medical, or care of elderly people wards, either as acute or elective admissions, in the previous 24 hours. Other eligibility criteria were expected length of stay of at least seven days and either limitation of activity and mobility (Braden scale activity and mobility scores of 1 or 2; box 2 5 ) or an existing pressure ulcer of grade 2 (using the skin grading tool from Nixon et al, 3 box 1). Elective surgical patients without limitation of activity and mobility or an existing pressure ulcer were eligible if the average length of hospital stay for their surgical procedure…”

INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial

“…Research suggests that with training, excellent inter-rater reliability (Kappa 1.0, i.e. 100% agreement between trained clinical trials nurses and their team leader) can be achieved (Nixon et al, 2005). During the trial, monitoring will occur, with the project manager using source data to verify the date entered into the electronic case report form.…”

Estudos clínicos sobre úlcera por pressão

“…Durante o processo de inspeção da pele em sítios considerados críticos para o desenvolvimento de UP, a escala de classificação adotada para o estagiamento dos níveis, mencionada em seis artigos (10,13,(17)(18)(19)21) incluídos nesta revisão integrativa adotaram o sistema de classificação adotado pela EPUAP (European Pressure Ulcer Advisory Panel) com graus de estagiamento que variam de I a IV.…”

“…Dois artigos (19,21) retrataram o problemas para classificar estas lesões, especialmente as de grau I, visto que não há descontinuidade na pele do paciente e algumas vezes esta lesão inicial não é percebida.…”