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Interrater agreement, reliability and validity of the Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale
Jan Kottner1, Martina Kenzler, Doris Wilborn
1Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Insights
The Glamorgan scale showed high agreement but low reliability for assessing pediatric pressure ulcer risk. It is not recommended for daily clinical use due to limited additional information provided.
Area of Science:
- Nursing
- Clinical Assessment
- Patient Safety
Background:
- Pressure ulcer risk assessment scales are crucial in clinical practice.
- Limited empirical evidence exists for the Glamorgan scale's performance in pediatric patients.
- 12 instruments are described for pediatric pressure ulcer risk assessment.
Purpose of the Study:
- To determine the interrater agreement and reliability of the Glamorgan scale's item and sum scores.
- To assess the validity of the Glamorgan scale sum scores for pressure ulcer risk.
Main Methods:
- An observational validation study was conducted in a pediatric cardiac unit.
- Simultaneous and independent assessments were performed by three nurses per situation.
- The Glamorgan scale and Visual Analogue Scale (VAS) were used to measure pressure ulcer risk.
Main Results:
- High agreement was found among item scores, but low reliability coefficients for item scores.
- Interrater reliability for Glamorgan scale sum scores was higher than for VAS scores.
- Moderate correlation was observed between the Glamorgan scale and VAS.
Conclusions:
- High agreement suggests nurses can make precise judgments, but low reliability indicates difficulty differentiating risk levels.
- The Glamorgan scale and VAS provided little additional clinical information in this low-risk setting.
- Both tools are not recommended for daily clinical decision-making in this context.
Aims And Objectives:
To determine (1) What is the degree of interrater agreement and reliability of Glamorgan scale item and sum scores? and (2) Are Glamorgan scale sum scores valid?
Background:
Pressure ulcer risk assessment scales are recommended for use in clinical practice. For paediatric patients, 12 instruments are currently described. Empirical evidence about the performance of Glamorgan scale scores in clinical practice is limited.
Design:
An observational validation study was conducted on a paediatric cardiac unit of a large university hospital in Germany in April and May 2010.
Methods:
Children were assessed simultaneously and independently by varying convenience samples of three nurses per assessment situation. Pressure ulcer risk was measured by the Glamorgan scale and a 100 mm Visual Analogue Scale (VAS). Proportions of agreement (po ), multirater kappa and intraclass correlation coefficients were calculated.
Results:
Thirty children were rated by 27 nurses. Median children's age was 5·5 years. Agreement among item scores was high, whereas reliability coefficients of item scores were low. Interrater reliability for the Glamorgan scale sum scores was higher than for VAS scores. Correlation between both scales was moderate.
Conclusions:
High agreement among item scores indicates that nurses are able to make precise judgements. The low interrater reliability of item and sum scores indicates that nurses were unable to differentiate the rated children based on their item and sum scores, thus providing little additional clinical relevant information about pressure ulcer risk in this setting.
Relevance To Clinical Practice:
The Glamorgan scale and the VAS are unable to make clear distinctions in a low-risk setting. Therefore, it is unlikely that the tools in this setting provide additional information for clinical decision making. Both tools are not recommended for daily use.
