University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Br J Dermatol. 2018 Jun;178(6):1331-1340. doi: 10.1111/bjd.16327. Epub 2018 Apr 19.
Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research.
To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties.
The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed.
The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62).
The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.
失禁相关性皮炎（IAD）是一种具有不同严重程度的特定类型刺激性接触性皮炎。为了支持临床实践和研究，需要一种国际公认的评估成人 IAD 严重程度的工具，该工具具有既定的诊断准确性、一致性和可靠性。
设计根特全球 IAD 分类工具（GLOBIAD）并评估其心理测量特性。
设计基于使用三轮 Delphi 程序的专家咨询，涉及来自 13 个国家的 34 名专家。该工具在来自 30 个国家的 823 名医疗保健专业人员的 IAD 照片样本中进行了测试，这些照片反映了不同的严重程度。评估了诊断准确性（敏感性和特异性）、一致性、评分者间可靠性（多评分者 Fleiss kappa）和评分者内可靠性（Cohen's kappa）的措施。
GLOBIAD 由两个类别组成，基于持续性红斑（类别 1）和皮肤缺失（类别 2）的存在，这两个类别均根据感染的临床体征的存在进行细分。区分类别 1 和类别 2 的一致性为 0.86[95%置信区间（CI）0.86-0.87]，敏感性为 90%，特异性为 84%。总体一致性为 0.55（95%CI 0.55-0.56）。区分类别 1 和类别 2 的 Fleiss kappa 为 0.65（95%CI 0.65-0.65）。总体 Fleiss kappa 为 0.41（95%CI 0.41-0.41）。区分类别 1 和类别 2 的 Cohen's kappa 为 0.76（95%CI 0.75-0.77）。总体 Cohen's kappa 为 0.61（95%CI 0.59-0.62）。
GLOBIAD 的开发是朝着在全球临床实践和研究中对 IAD 进行更好的系统评估迈出的重要一步。然而，还需要进一步验证。
