Van Tiggelen H, LeBlanc K, Campbell K, Woo K, Baranoski S, Chang YY, Dunk AM, Gloeckner M, Hevia H, Holloway S, Idensohn P, Karadağ A, Koren E, Kottner J, Langemo D, Ousey K, Pokorná A, Romanelli M, Santos VLCG, Smet S, Tariq G, Van den Bussche K, Van Hecke A, Verhaeghe S, Vuagnat H, Williams A, Beeckman D, et al.
The British journal of dermatology. Date of publication 2019 Oct 12;volume ():.
1. Br J Dermatol. 2019 Oct 12. doi: 10.1111/bjd.18604. [Epub ahead of print]
Standardizing the classification of skin tears: validity and reliability testing
of the International Skin Tear Advisory Panel Classification System in 44
countries.
Van Tiggelen H(1), LeBlanc K(2)(3), Campbell K(2), Woo K(4), Baranoski S(5),
Chang YY(6), Dunk AM(7)(8), Gloeckner M(9), Hevia H(10), Holloway S(11), Idensohn
P(12)(13)(14), Karadağ A(15), Koren E(16)(17), Kottner J(1)(18), Langemo
D(19)(20), Ousey K(21)(22)(23), Pokorná A(24), Romanelli M(25), Santos
VLCG(26)(27), Smet S(28), Tariq G(29), Van den Bussche K(1), Van Hecke A(30)(31),
Verhaeghe S(30)(32), Vuagnat H(33), Williams A(34), Beeckman
D(1)(23)(35)(36)(37).
Author information:
(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.
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.
© 2019 The Authors. British Journal of Dermatology published by John Wiley & Sons
Ltd on behalf of British Association of Dermatologists.
DOI: 10.1111/bjd.18604
PMID: 31605618
