Inter-rater reliability of four validated diabetic foot ulcer classification systems

The need to classify, score and describe diabetic foot ulcerations is needed for accurate clinical documentation. An agreed wound classification can improve communication between health care professionals, and improve ease of discussion regarding potential outcomes. This study aimed to determine the inter-rater reliability between four validated wound classification systems.

A prospective non-experimental comparative study was conducted. Forty patients with diabetes presenting with a new or long-standing ulceration were recruited. Each ulcer was graded/scored by three clinicians using four widely used classification systems; namely the University of Texas, SINBAD, Meggitt-Wagner and the PEDIS scoring systems.

All classifications had a satisfactory inter-rater agreement when evaluated by three raters of various clinical experience, however, the strength of the agreement varied between classifications. The Meggitt-Wagner system had an almost perfect agreement, the SINBAD and UT systems had a strong inter-rater agreement whilst the PEDIS had a moderate inter-rater agreement.

Results of study serve as assurance and provides the evidence that these systems may be reliably used by different clinicians, even those with varied experience in wound care.