Cultural adaptation and reliability of the ISTAP Skin Tear Classification System to Chilean Spanish

The International Skin Tear Advisory Panel (ISTAP) created the ISTAP Skin Tear Classification System with the aim of promoting a common and universal language to describe, classify and document skin tears, and increase awareness of the high prevalence of these wounds. Although there is a Spanish version of the ISTAP Skin Tear Classification System, the authors considered it relevant to have a specific Chilean Spanish version. The aim was to achieve the cultural adaptation of the ISTAP Skin Tear Classification System to Chilean Spanish, and verify its content validity and inter-rater reliability.

The study consisted of two phases: cultural adaptation of the ISTAP Skin Tear Classification System into Chilean Spanish, and validation of the culturally adapted system. A convenience sample of 150 health professionals classified 30 photographs of skin tears, using the same photographs used in the original ISTAP skin tear classification and validation study. Additionally, the clinical application of the classification system was tested among 20 nurses, who assessed and classified the skin tears (n=24) of hospitalised patients. For analysis of the inter-rater reliability, Fleiss' kappa was used.

The differences found in the translation referred to a synonym of the terms 'skin' or 'cutaneous', and the terms 'flap' or 'tear'. Once analysed and discussed, the term 'desgarro' was maintained, which is the translation of the English term 'flap'. There is no equivalent term for 'skin tears' in Spanish, but consensus was reached by researchers and collaborators to use the phrase: 'desgarro de piel'. Once a consensus was reached on the wording for the translation, back-translation was completed and compared with the original English version and reviewed by the original author of the classification for accuracy. The content validity of the translated version of the ISTAP Skin Tear Classification System into Chilean Spanish showed a moderate agreement for the non-specialised nurses' group (0.4804) and for the specialised nurses' group (0.5308). Inter-rater reliability was achieved by obtaining a moderate agreement (Fleiss' kappa=0.53) and an almost perfect level of agreement for clinical application (Fleiss' kappa=0.83).

The reported content validity and inter-rater reliability support the applicability of the cultural adaptation of the ISTAP Skin Tear Classification System to Chilean Spanish into practice.