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Moisture lesions: interrater agreement and reliability.

Jan Kottner1, Ruud Halfens

  • 1Centre for Humanities and Health Sciences, Department of Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany. jan.kottner@charite.de

Journal of Clinical Nursing
|May 27, 2010
PubMed
Summary

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.

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  • 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.