College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
The Townsville University Hospital, Townsville, Queensland, Australia.
J Tissue Viability. 2022 Aug;31(3):395-403. doi: 10.1016/j.jtv.2022.05.002. Epub 2022 May 20.
To evaluate consistency in the assessment of neonatal skin injuries.
Injury images collected during a multicentre period prevalence study (n = 297) were screened for optimal quality before 60 images, stratified for size and colour, were randomly selected for assessment by three neonatal and two adult specialists. The principal investigator's assessments were the baseline for comparison and consistency. Injury characteristics and assessments were reported as descriptive statistics. Comparison of injury assessments for colour and stage were calculated using Chi-square, with p-value of <0.05 considered significant.
Neonatal specialists assessed injury elements more confidently than adult specialists reporting 59-60 (98-100%) injuries visible compared to 51-53 (85-93%) respectively. Neonatal specialists attributed mechanical force to 93% of the skin injuries compared to 70% by adult specialists. Consistency of colour assessment was achieved more often with neonatal specialists (n = 50, 85%), compared to adult specialists (n = 41, 73%). Neonatal specialists' consistency for injury staging (n = 107, 60%) was higher compared to adult specialists who were uncertain (n = 8,16%) and less consistent (n = 47, 44%). When comparing specialists as a group, consistency with baseline assessment was significantly different between neonatal and adult specialists for colour (p < 0.010) and injury stage (p < 0.009).
Field of expertise (neonatal versus adult) differences were noted likely related to experience and understanding of empirical differences between neonatal and adult skin structure and maturity. These results highlight the need for specialist neonatal skin injury and wound training for clinicians involved in assessment, treatment and best practices for neonates.
评估新生儿皮肤损伤评估的一致性。
在一项多中心时期患病率研究（n=297）中收集的损伤图像在筛选出 60 张最佳质量的图像之前，根据大小和颜色进行分层，然后随机选择 60 张图像由三名新生儿和两名成人专家进行评估。主要研究者的评估是比较和一致性的基线。损伤特征和评估结果以描述性统计数据报告。使用卡方检验比较损伤颜色和阶段的评估，p 值<0.05 被认为具有统计学意义。
新生儿专家比成人专家更自信地评估损伤元素，报告分别有 59-60%（98-100%）的损伤可见，而 51-53%（85-93%）的损伤可见。新生儿专家将机械力归因于 93%的皮肤损伤，而成人专家归因于 70%的皮肤损伤。新生儿专家在颜色评估方面的一致性（n=50，85%）比成人专家（n=41，73%）更常见。新生儿专家在损伤分期方面的一致性（n=107，60%）高于成人专家的不确定（n=8，16%）和不一致（n=47，44%）。当将专家作为一个整体进行比较时，新生儿和成人专家在颜色（p<0.010）和损伤分期（p<0.009）方面的基线评估一致性有显著差异。
注意到专业领域（新生儿与成人）的差异，这可能与新生儿和成人皮肤结构和成熟度之间的经验和理解有关。这些结果强调了需要为参与评估、治疗和新生儿最佳实践的临床医生提供专门的新生儿皮肤损伤和伤口培训。
