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Standardising the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries
Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada; Wound Ostomy Continence Institute/ Association of Nurses Specialized in Wound Ostomy Continence, Canada.
School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
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2020 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 183, no 1, p. 146-154Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Skin tears are acute wounds that are frequently misdiagnosed and underreported. A standardised 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 multi-country 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 intra-rater 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% 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 intra-rater 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 a systematic assessment and reporting of skin tears in clinical practice and research globally.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2020. Vol. 183, no 1, p. 146-154
Keywords [en]
Classification, ISTAP, Psychometric evaluation, Reliability, Skin tear, Validity
National Category
Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:oru:diva-77255DOI: 10.1111/bjd.18604ISI: 000545517600046PubMedID: 31605618Scopus ID: 2-s2.0-85075950572OAI: oai:DiVA.org:oru-77255DiVA, id: diva2:1360644
Note

Funding Agency:

International Skin Tear Advisory Panel (ISTAP)

Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2020-08-14Bibliographically approved

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Beeckman, Dimitri

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