Defloor Tom, Schoonhoven Lisette
Nursing Science, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium.
J Clin Nurs. 2004 Nov;13(8):952-9. doi: 10.1111/j.1365-2702.2004.00974.x.
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.
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.
Survey was among pressure ulcer experts.
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.
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).
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.
The ability to determine correctly whether 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.
文献中讨论了许多用于压疮分级的分类系统。正确识别和分类压疮对于准确报告问题的严重程度以及及时预防至关重要。压疮分类系统的可靠性很少得到检验。
本文旨在研究使用压疮照片时，根据欧洲压疮咨询小组分类系统对压疮进行分类的评估者间信度。
对压疮专家进行调查。
向44位压疮专家展示了56张照片。专家们将病变分类为正常皮肤、可褪色红斑、压疮（四个等级）或失禁性皮炎。计算评估者间信度。
整个专家组的多评估者卡方值为0.80（P < 0.001）。不同专家组得到了可比的结果。分类差异主要限于1度的差异。失禁性皮炎最常与2级（水疱）和3级压疮（浅表性压疮）混淆。
欧洲压疮咨询小组分类的评估者间信度对于专家评估照片似乎良好。失禁性皮炎与水疱或浅表性压疮之间的差异似乎并不总是很明显。
正确判断病变是否为压疮病变的能力对于评估预防措施的有效性很重要。此外，正确区分压疮和失禁性皮炎的能力也很重要，因为它们需要不同的预防措施。错误的分类会导致错误的措施和负面结果。照片可作为一种实践工具，用于学习区分压疮和失禁性皮炎，并了解不同等级的压疮。已开发出压疮分类软件包以促进学习。
