• agreement;
  • child;
  • infant;
  • nursing;
  • pressure ulcer;
  • reliability;
  • reproducibility;
  • validity

Aims and objectives

To determine (1) What is the degree of interrater agreement and reliability of Glamorgan scale item and sum scores? and (2) Are Glamorgan scale sum scores valid?


Pressure ulcer risk assessment scales are recommended for use in clinical practice. For paediatric patients, 12 instruments are currently described. Empirical evidence about the performance of Glamorgan scale scores in clinical practice is limited.


An observational validation study was conducted on a paediatric cardiac unit of a large university hospital in Germany in April and May 2010.


Children were assessed simultaneously and independently by varying convenience samples of three nurses per assessment situation. Pressure ulcer risk was measured by the Glamorgan scale and a 100 mm Visual Analogue Scale (VAS). Proportions of agreement (po), multirater kappa and intraclass correlation coefficients were calculated.


Thirty children were rated by 27 nurses. Median children's age was 5·5 years. Agreement among item scores was high, whereas reliability coefficients of item scores were low. Interrater reliability for the Glamorgan scale sum scores was higher than for VAS scores. Correlation between both scales was moderate.


High agreement among item scores indicates that nurses are able to make precise judgements. The low interrater reliability of item and sum scores indicates that nurses were unable to differentiate the rated children based on their item and sum scores, thus providing little additional clinical relevant information about pressure ulcer risk in this setting.

Relevance to clinical practice

The Glamorgan scale and the VAS are unable to make clear distinctions in a low-risk setting. Therefore, it is unlikely that the tools in this setting provide additional information for clinical decision making. Both tools are not recommended for daily use.