Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries.

BACKGROUND: Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. OBJECTIVES: To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. METHODS: A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument. RESULTS: A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75). CONCLUSIONS: The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.

Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System.

OBJECTIVE: The aim of this study was to translate, validate and establish reliability of the International Skin Tear Classification System in Danish. METHOD: Phase 1 of the project involved the translation of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System into Danish, using the forward-back translation method described by the principles of good practice for the translation process for patient-reported outcomes. In Phase 2, the Danish group sought to replicate the ISTAP validation study and validate the classification system with registered nurses (RN) and social and health-care assistants (non-RN) from both primary health care and a Danish university hospital in Copenhagen. Thirty photographs, with equal representation of the three types of skin tears, were selected to test validity. The photographs chosen were those originally used for internal and external validation by the ISTAP group. The subjects were approached in their place of work and invited to participate in the study and to attend an educational session related to skin tears. RESULTS: The Danish translation of the ISTAP classification system was tested on 270 non-wound specialists. The ISTAP classification system was validated by 241 RNs, and 29 non-RN. The results indicated a moderate level of agreement on classification of skin tears by type (Fleiss' Kappa=0.460). A moderate level of agreement was demonstrated for both the RN group and the non-RN group (Fleiss' Kappa=0.464 and 0.443, respectively). CONCLUSION: The ISTAP Skin Tear Classification System was developed with the goal of establishing a global language for describing and documenting skin tears and to raise the health-care community's awareness of skin tears. The Danish translation of the ISTAP classification system supports the earlier ISTAP study and further validates the classification system. The Danish translation of the classification system is vital to the promotion of skin tears in both research and the clinical settings in Denmark.

Wound assessment and dressing selection.

The treatment of acute and chronic wounds has evolved into a highly specialized arena. Therefore, educating healthcare professionals on the appropriateness of dressings and the principles that govern their use has become a major concern. This manuscript discusses wound assessment and its relationship to dressing selection. Use of the principles of wound care, assessment parameters and dressing options should be a part of all healthcare endeavors when choosing the right dressing for the right wound.

Wound dressings: challenging decisions.

Choosing the appropriate wound dressing is critical to positive patient outcomes. This article helps the nurse choose dressings based on principles of wound care management and comprehensive assessment. Tools are provided to choose the different products that can be used as the wound progresses through the stages of healing.

Skin tears.

Skin tears are a serious, painful problem for older patients. Find out how your staff can recognize patients at risk, what they can do to prevent skin tears, and how to manage them effectively if they occur.

Collaborative roles lead to success in wound healing.

Collaboration among all healthcare disciplines leads to success in planning strategies to prevent, treat, or heal pressure ulcers. Collaboration requires a respect for each discipline's scope of knowledge and uniqueness of functions as well as cooperation and communication in all aspects of patient care. The patient should be considered the quarterback and all the disciplines are merely the players.

Obstacles and opportunities for the multidisciplinary wound care team. A report for the clinical symposium on wound management.

On the last day of the 12th Annual Clinical Symposium on Wound Management, a panel of clinicians from various disciplines, and with diverse experience in wound management, discussed the challenges and rewards of being part of a multidisciplinary team caring for patients with wounds. Panelists included Sharon Baranoski, MSN, RN, CETN; C. Andrew Salzberg, MD; Marlys J. Staley, MS, PT; and David R. Thomas, MD, FACP. Elizabeth A. Ayello, PhD, RN, CS, CETN, was the moderator. An excerpt from this session is published here.

Nursing and industry: a time for collaboration.

Collaboration between industry and clinical sites is an excellent way to foster research and improve patient care. A seven-step program for collaboration was illustrated by a clinical trial of a new dressing, Ventex (Kendall Health Care Products Co.). The seven steps are (1) Establish basis for collaboration; (2)sign agreements or contracts; (3) develop a project plan; (4) develop the protocol; (5) implement the study; (6) analyze the data and report results; and (7) present conclusions and publish results. Dressing performance, clinician and patient acceptance, and healing indicate that the dressing is feasible for a variety of wounds in a variety of settings.