Lund CH, Osborne JW, et al.
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN. Date of publication 2004 May 1;volume 33(3):320-7.
1. J Obstet Gynecol Neonatal Nurs. 2004 May-Jun;33(3):320-7. doi:
10.1177/0884217504265174.
Validity and reliability of the neonatal skin condition score.
Lund CH(1), Osborne JW.
Author information:
(1)Intensive Care Nursery, Children's Hospital, Oakland, CA 94609, USA.
OBJECTIVE: To demonstrate the validity and reliability of the Neonatal Skin
Condition Scale (NSCS) used in the Association of Women's Health, Obstetric and
Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN)
neonatal skin care evidence-based practice project.
SETTING: NICU and well-baby units in 27 hospitals located throughout the United
States.
PARTICIPANTS: Site coordinators (N = 27) and neonates (N = 1,006) observed
during both the pre and postimplementation phases of the original neonatal skin
care project.
METHOD: To assess reliability, two consecutive NSCS assessments on a single
infant were analyzed. Site coordinators were contacted after the original
project was concluded. Sites indicating that a single nurse scored all infant
skin observations provided data that were used to evaluate intrarater
reliability. Sites using more than one nurse to score skin observations provided
data that were used to assess interrater reliability. To assess validity, the
following variables were used from the original data set: the Neonatal Skin
Condition Scale (NSCS), with three subscales for dryness, erythema, and
breakdown; birth weight in grams; number of skin score observations for each
infant; and the prevalence of infection, defined as a positive blood culture.
RESULTS: For intrarater reliability, 16 sites used a single nurse for all NSCS
assessments; total NSCS assessments 475. For interrater reliability, 11 sites
used multiple raters; total assessments 531. The NSCS demonstrated adequate
reliability for each of the three subscales and for the total score, with the
percent agreement between scores ranging from 68.7% to 85.4% (intrarater) and
65.9% to 89% (interrater); all Kappas were significant at p < .001 and were in
the moderate range for reliability. The validity of the NSCS was demonstrated by
the findings that smaller infants were 6 times more likely to have erythema
(chi2(6) = 109.55, p < .0001), and approximately twice as likely to have the
most severe breakdown (chi2(6) = 108.01, p < .0001). Infants with more
observations (longer length of stay) had higher skin scores (odds ratio = 1.21,
p < .0001), and an increased probability of infection was noted for infants with
higher skin scores (odds ratio = 2.25, p < .0001).
CONCLUSIONS: The Neonatal Skin Condition Score (NSCS) is reliable when used by
single and multiple raters to assess neonatal skin condition, even across weight
groups and racial groups. Validity of the NSCS was demonstrated by confirmation
of the relationship of the skin condition scores with birth weight, number of
observations, and prevalence of infection.
DOI: 10.1177/0884217504265174
PMID: 15180195 [Indexed for MEDLINE]
