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

H Van Tiggelen; K LeBlanc; K Campbell; K Woo; S Baranoski; Y Y Chang; A M Dunk; M Gloeckner; H Hevia; S Holloway; P Idensohn; A Karadağ; E Koren; J Kottner; D Langemo; K Ousey; A Pokorná; M Romanelli; V L C G Santos; S Smet; G Tariq; K Van den Bussche; A Van Hecke; S Verhaeghe; H Vuagnat; A Williams; D Beeckman

doi:10.1111/bjd.18604

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

Br J Dermatol. 2020 Jul;183(1):146-154. doi: 10.1111/bjd.18604. Epub 2019 Nov 28.

Authors

H Van Tiggelen¹, K LeBlanc^{2

3}, K Campbell², K Woo⁴, S Baranoski⁵, Y Y Chang⁶, A M Dunk^{7

8}, M Gloeckner⁹, H Hevia¹⁰, S Holloway¹¹, P Idensohn^{12

13

14}, A Karadağ¹⁵, E Koren^{16

17}, J Kottner^{1

18}, D Langemo^{19

20}, K Ousey^{21

22

23}, A Pokorná²⁴, M Romanelli²⁵, V L C G Santos^{26

27}, S Smet²⁸, G Tariq²⁹, K Van den Bussche¹, A Van Hecke^{30

31}, S Verhaeghe^{30

32}, H Vuagnat³³, A Williams³⁴, D Beeckman^{1

23

35

36

37}

Affiliations

¹ Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care.
² School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.
³ Wound Ostomy Continence Institute/Association of Nurses Specialized in Wound Ostomy Continence, Ottawa, ON, Canada.
⁴ School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
⁵ Nursing Advisory Board, Rasmussen College, Romeoville/Joliet, IL, U.S.A.
⁶ Division of Nursing, Speciality Nursing (Wound Care), Singapore General Hospital, Bukit Merah, Singapore.
⁷ Tissue Viability Unit, Canberra Hospital, Canberra Health Services, Canberra, ACT, Australia.
⁸ School of Nursing, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
⁹ UnityPoint Health Trinity, Rock Island, Illinois and Bettendorf, IA, U.S.A.
¹⁰ Nursing School, Nursing Department, Andrés Bello University, Viña del Mar, Chile.
¹¹ Centre for Medical Education, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, U.K.
¹² CliniCare Medical Centre, Ballito, KwaZulu-Natal, South Africa.
¹³ School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, U.K.
¹⁴ School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
¹⁵ School of Nursing, Koc University, Istanbul, Turkey.
¹⁶ Leumit HMO, Vascular Ulcer Clinic, Geula, Jerusalem, Israel.
¹⁷ Israeli Wound Care Management and Research Association (IWCMRA), Jerusalem, Israel.
¹⁸ Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁹ College of Nursing, University of North Dakota, Grand Forks, ND, U.S.A.
²⁰ Langemo and Associates, Grand Forks, ND, U.S.A.
²¹ Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, U.K.
²² School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
²³ School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
²⁴ Department of Nursing, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
²⁵ Department of Dermatology, University of Pisa, Pisa, Italy.
²⁶ School of Nursing, Medical-Surgical Nursing Department, University of São Paulo, São Paulo, Brazil.
²⁷ School of Nursing, Portuguese Catholic University, Porto, Portugal.
²⁸ Wound Care Center.
²⁹ Wound Care Unit, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, U.A.E.
³⁰ University Centre for Nursing and Midwifery, Department of Public Health and Primary Care.
³¹ Nursing Department, Ghent University, Ghent, Belgium.
³² Department Health Care, VIVES University College, Roeselare, Belgium.
³³ Centre for Wounds and Wound Healing, University Hospitals of Geneva, Geneva, Switzerland.
³⁴ Wound and Ostomy Care, Reston Hospital Center, Reston, VA, U.S.A.
³⁵ School of Health Sciences, Örebro University, Örebro, Sweden.
³⁶ Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Ødense, Denmark.
³⁷ School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia.

Abstract

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Lacerations* / diagnosis
Reproducibility of Results
Skin / injuries
Soft Tissue Injuries*
Surveys and Questionnaires

Grants and funding

International Skin Tear Advisory Panel (ISTAP)/International