Vermeulen Hester, Ubbink Dirk T, Schreuder Sanne M, Lubbers Maarten J
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Clin Nurs. 2007 Jul;16(7):1270-7. doi: 10.1111/j.1365-2702.2007.01789.x.
Primary: to study the level of agreement among nurses and doctors in classifying the colour and exudation of open wounds according to the Red-Yellow-Black scheme. Secondary: to check their agreement with an international expert panel on whether their classification was correct.
Nurses and doctors classify open wounds to assess systemic and local treatment options. Nowadays, several classification schemes are being used. The Red-Yellow-Black-scheme is commonly used for classifying open wounds or is part of other, more intricate, wound classification models.
Eighteen representative photographs of red, yellow and black wounds were presented to 63 nurses and 79 doctors from the Department of Surgery. They classified these open wounds for colour and amount of exudation. Group kappa's (kappa) were calculated to assess inter- and intra-observer agreement and their agreement with an expert panel.
Agreement among the 63 nurses on wound colour (kappa = 0.61; 95% CI: 0.49-0.74) and exudation (kappa = 0.49; 95% CI: 0.29-0.68) was moderate to good. Agreement among the 79 doctors was similar: kappa = 0.61; 95% CI 0.49-0.73 for wound colour and kappa = 0.48; 95% CI: 0.36-0.61 for exudation. Nurses' and doctors' agreement with the expert panel was also moderate to good: kappa-values ranged between 0.48 and 0.77.
Based on the good to moderate inter-observer agreement as found in this study, the Red-Yellow-Black -scheme appears to be a reliable and accurate classification scheme to assess open (surgical) wounds. Such a scheme may enable nurses and doctors to select the appropriate treatment modalities and evaluate the progress of the healing process.
The Red-Yellow-Black scheme is a helpful tool to classify all kinds of wounds and can be used as stand-alone classification method or as part of wound management concepts.
主要目的是研究护士和医生根据红-黄-黑分类法对开放性伤口的颜色和渗出物进行分类时的一致性水平。次要目的是检查他们在分类是否正确方面与国际专家小组的一致性。
护士和医生对开放性伤口进行分类以评估全身和局部治疗方案。如今，有几种分类方案正在被使用。红-黄-黑分类法常用于开放性伤口的分类，或是其他更复杂的伤口分类模型的一部分。
向外科的63名护士和79名医生展示了18张红色、黄色和黑色伤口的代表性照片。他们对这些开放性伤口的颜色和渗出量进行分类。计算组内相关系数（kappa）以评估观察者间和观察者内的一致性以及他们与专家小组的一致性。
63名护士在伤口颜色（kappa = 0.61；95%置信区间：0.49 - 0.74）和渗出物（kappa = 0.49；95%置信区间：0.29 - 0.68）方面的一致性为中等至良好。79名医生的一致性类似：伤口颜色的kappa = 0.61；95%置信区间0.49 - 0.73，渗出物的kappa = 0.48；95%置信区间：0.36 - 0.61。护士和医生与专家小组的一致性也为中等至良好：kappa值在0.48至0.77之间。
基于本研究中发现的观察者间良好至中等的一致性，红-黄-黑分类法似乎是评估开放性（手术）伤口的可靠且准确的分类方案。这样的方案可能使护士和医生能够选择合适的治疗方式并评估愈合过程的进展。
红-黄-黑分类法是对各类伤口进行分类的有用工具，可作为独立的分类方法或作为伤口管理概念的一部分使用。
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