A systematic review of interrater reliability of pressure ulcer classification systems

Authors

  • Jan Kottner,

    1. Authors: Jan Kottner, MA, RN, Associate Professor, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Kathrin Raeder, RN, Master Student, Certified Wound Expert, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Ruud Halfens, PhD, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Sciences, Universiteit Maastricht, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Director of the Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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  • Kathrin Raeder,

    1. Authors: Jan Kottner, MA, RN, Associate Professor, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Kathrin Raeder, RN, Master Student, Certified Wound Expert, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Ruud Halfens, PhD, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Sciences, Universiteit Maastricht, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Director of the Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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  • Ruud Halfens,

    1. Authors: Jan Kottner, MA, RN, Associate Professor, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Kathrin Raeder, RN, Master Student, Certified Wound Expert, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Ruud Halfens, PhD, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Sciences, Universiteit Maastricht, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Director of the Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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  • Theo Dassen

    1. Authors: Jan Kottner, MA, RN, Associate Professor, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Kathrin Raeder, RN, Master Student, Certified Wound Expert, Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany; Ruud Halfens, PhD, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Sciences, Universiteit Maastricht, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Director of the Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Jan Kottner, Charité-Universitätsmedizin Berlin, Department of Nursing Science, Centre for Humanities and Health Sciences, Charitéplatz 1, 10117 Berlin, Germany. Telephone: +49 30 450 529 054.
E-mail:jan.kottner@charite.de

Abstract

Aims.  To review systematically the interrater reliability of pressure ulcer classification systems to find out which classification should be used in daily practice.

Background.  Pressure ulcer classification systems are important tools in research and practice. They aim at providing accurate and precise communication, documentation and treatment decisions. Pressure ulcer classifications are criticised for their low degree of interrater reliability.

Design.  Systematic review.

Methods.  The data bases MEDLINE, EMBASE, CINAHL and the World Wide Web were searched. Original research studies estimating interrater reliability of pressure ulcer classification systems were included. Study selection, data extraction and quality assessment was conducted independently by two reviewers.

Results.  Twenty-four out of 339 potentially relevant studies were included in the final data synthesis. Due to the heterogeneity of the studies a meaningful comparison was impossible.

Conclusions.  There is at present not enough evidence to recommend a specific pressure ulcer classification system for use in daily practice. Interrater reliability studies are required, in which comparable raters apply different pressure ulcer classification systems to comparable samples.

Relevance to clinical practice.  It is necessary to determine the interrater reliability of pressure ulcer classifications among all users in clinical practice. If interrater reliability is low the use of those systems is questionable. On the basis of this review there are no recommendations as to which system is to be given preference.

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