To Örebro University

Background: Skin tear classifications support the assessment and reporting of skin tears in a consistent way. The measurement properties of skin tear classifications have not been compared so far.

Objectives: To critically appraise, compare and summarise the quality of the measurement properties of available skin tear classifications.

Design: Systematic review.

Methods: The databases MEDLINE, EMBASE, CINAHL and CENTRAL were systematically searched until January 2020. Studies reporting the development and/or the evaluation of measurement properties of skin tear classifications were included. The COSMIN Risk of Bias checklist was applied to evaluate the methodological quality of the included studies. Each reported measurement property was rated against criteria for good measurement properties. The evidence was summarised and the quality of the evidence was graded using a modified GRADE approach. Study selection, data extraction and quality appraisal were conducted independently by two reviewers and double-checked by a third reviewer.

Results: Fourteen studies, describing five classifications, were included. Content validity was examined in five studies, reliability in nine studies, measurement error in two studies, and criterion validity in four studies. For three classification systems, no measurement properties were reported.

Conclusions: Five skin tear classifications exist, of which only two have been psychometrically tested. The quality of evidence on their measurement properties varied between very low to moderate. To date, the ISTAP classification is the most commonly evaluated system with moderate quality evidence to support its reliability, measurement error and criterion validity. More well-designed studies using direct skin observations are needed.

Tweetable abstract: A systematic review of the measurement properties of skin tear classifications.