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Moisture lesions: interrater agreement and reliability
1Centre for Humanities and Health Sciences, Department of Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany. jan.kottner@charite.de
Aims And Objectives:
The aim of this study was to examine interrater reliability and agreement of the diagnosis of moisture lesions as defined by the European Pressure Ulcer Advisory Panel.
Background:
Differentiation between superficial pressure ulcers and moisture-related skin damages is difficult. To enhance the precision of the identification of moisture lesions, the European Pressure Ulcer Advisory Panel provided wound- and patient-related characteristics. Empirical evidence regarding interrater reliability and agreement among nurses for the detection of moisture-related skin damages in clinical practice is lacking.
Design:
Observational.
Methods:
Home care clients (n = 339) were independently assessed twice by trained nurses. A head to toe skin inspection was conducted.
Results:
For the diagnosis of moisture lesion (yes/no), nurses exactly agreed in 95% of all assessed clients. Interrater reliability was intraclass correlation coefficient (1,1) = 0.67 (95% CI 0.61-0.73).
Conclusions:
Nurses were able to differentiate between home care clients with and without moisture lesions but assessment results contained a high degree of measurement error. It seems that the descriptions for the identification of moisture lesions provided by the European Pressure Ulcer Advisory Panel do support the diagnostic process but reliability must be enhanced.
Relevance To Clinical Practice:
Because of low interrater reliability, it is questionable whether the diagnosis of moisture lesions in clinical practice is valid. Measurement error is too high to make adequate inferences for individuals. Definitions and descriptions provided by the European Pressure Ulcer Advisory Panel, provisions of a single training and images are not sufficient to achieve acceptable interrater reliability in clinical practice.
Insights
Nurses can identify moisture lesions, but reliability is low. The European Pressure Ulcer Advisory Panel
Area of Science:
- Dermatology
- Nursing Science
- Clinical Assessment
Background:
- Differentiating moisture lesions from pressure ulcers is challenging.
- European Pressure Ulcer Advisory Panel (EPUAP) guidelines aim to improve moisture lesion identification.
- Limited empirical data exists on interrater reliability for moisture lesion diagnosis among nurses.
Purpose of the Study:
- To evaluate the interrater reliability and agreement in diagnosing moisture lesions using EPUAP criteria.
- To assess the effectiveness of EPUAP definitions in clinical practice for moisture lesion detection.
Main Methods:
- An observational study involving 339 home care clients.
- Independent, twice-repeated skin assessments by trained nurses using a head-to-toe inspection.
- Data collected on the presence or absence of moisture lesions.
Main Results:
- Exact agreement on moisture lesion diagnosis (yes/no) was achieved in 95% of cases.
- Interrater reliability, measured by the intraclass correlation coefficient, was 0.67 (95% CI 0.61-0.73).
- While nurses could differentiate, a significant degree of measurement error was noted.
Conclusions:
- Nurses can distinguish between clients with and without moisture lesions, but with considerable measurement error.
- EPUAP descriptions aid diagnosis, yet reliability needs improvement for clinical validity.
- Current EPUAP guidelines, training, and visuals are insufficient for acceptable interrater reliability in clinical settings.
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