Standardising the classification of skin tears

validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries

H. Van Tiggelen, Kim LeBlanc, Karen Campbell, Kevin 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, Karen Ousey, A Pokorná, M Romanelli, V.L.C.G. Santos, S Smet & 7 others G Tariq, K Van den Bussche, A Van Hecke, S Verhaeghe, H Vuagnat, A. Williams, D Beeckman

Research output: Contribution to journalReview article

Abstract

Background:
Skin tears are acute wounds that are frequently misdiagnosed and underreported. A standardised 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 multi‐country 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 intra‐rater 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% 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 intra‐rater 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 a systematic assessment and reporting of skin tears in clinical practice and research globally.
Original languageEnglish
Number of pages23
JournalBritish Journal of Dermatology
Early online date12 Oct 2019
DOIs
Publication statusE-pub ahead of print - 12 Oct 2019

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Reproducibility of Results
Skin
Expert Systems
Diagnostic Errors
Referral and Consultation
Delivery of Health Care

Cite this

Van Tiggelen, H. ; LeBlanc, Kim ; Campbell, Karen ; Woo , Kevin ; Baranoski, S ; Chang, Y Y ; Dunk, A.M. ; Gloeckner, M ; Hevia, H ; Holloway, S ; Idensohn, P ; Karadağ, A ; Koren, E ; Kottner, J ; Langemo, D ; Ousey, Karen ; Pokorná, A ; Romanelli, M ; Santos, V.L.C.G. ; Smet, S ; Tariq, G ; Van den Bussche, K ; Van Hecke, A ; Verhaeghe, S ; Vuagnat, H ; Williams, A. ; Beeckman, D. / Standardising the classification of skin tears : validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries. In: British Journal of Dermatology. 2019.
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title = "Standardising the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries",
abstract = "Background:Skin tears are acute wounds that are frequently misdiagnosed and underreported. A standardised 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 multi‐country 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 intra‐rater 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{\%} 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 intra‐rater 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 a systematic assessment and reporting of skin tears in clinical practice and research globally.",
keywords = "Skin tear, Classification, ISTAP, Psychometric evaluation, Validity, Reliability",
author = "{Van Tiggelen}, H. and Kim LeBlanc and Karen Campbell and Kevin Woo and S Baranoski and Chang, {Y Y} and A.M. Dunk and M Gloeckner and H Hevia and S Holloway and P Idensohn and A Karadağ and E Koren and J Kottner and D Langemo and Karen Ousey and A Pokorn{\'a} and M Romanelli and V.L.C.G. Santos and S Smet and G Tariq and {Van den Bussche}, K and {Van Hecke}, A and S Verhaeghe and H Vuagnat and A. Williams and D Beeckman",
year = "2019",
month = "10",
day = "12",
doi = "10.1111/bjd.18604",
language = "English",
journal = "British Journal of Dermatology",
issn = "0007-0963",
publisher = "Wiley-Blackwell",

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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 2019, 'Standardising the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries', British Journal of Dermatology. https://doi.org/10.1111/bjd.18604

Standardising the classification of skin tears : validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries. / Van Tiggelen, H. ; LeBlanc, Kim; Campbell, Karen ; Woo , Kevin; Baranoski, S; Chang, Y Y ; Dunk, A.M. ; Gloeckner, M; Hevia, H; Holloway, S; Idensohn, P; Karadağ, A; Koren, E; Kottner, J; Langemo, D; Ousey, Karen; Pokorná, A; Romanelli, M; Santos, V.L.C.G. ; Smet, S; Tariq, G; Van den Bussche, K; Van Hecke, A; Verhaeghe, S; Vuagnat, H; Williams, A.; Beeckman, D.

In: British Journal of Dermatology, 12.10.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Standardising the classification of skin tears

T2 - validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries

AU - Van Tiggelen, H.

AU - LeBlanc, Kim

AU - Campbell, Karen

AU - Woo , Kevin

AU - Baranoski, S

AU - Chang, Y Y

AU - Dunk, A.M.

AU - Gloeckner, M

AU - Hevia, H

AU - Holloway, S

AU - Idensohn, P

AU - Karadağ, A

AU - Koren, E

AU - Kottner, J

AU - Langemo, D

AU - Ousey, Karen

AU - Pokorná, A

AU - Romanelli, M

AU - Santos, V.L.C.G.

AU - Smet, S

AU - Tariq, G

AU - Van den Bussche, K

AU - Van Hecke, A

AU - Verhaeghe, S

AU - Vuagnat, H

AU - Williams, A.

AU - Beeckman, D

PY - 2019/10/12

Y1 - 2019/10/12

N2 - Background:Skin tears are acute wounds that are frequently misdiagnosed and underreported. A standardised 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 multi‐country 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 intra‐rater 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% 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 intra‐rater 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 a systematic assessment and reporting of skin tears in clinical practice and research globally.

AB - Background:Skin tears are acute wounds that are frequently misdiagnosed and underreported. A standardised 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 multi‐country 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 intra‐rater 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% 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 intra‐rater 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 a systematic assessment and reporting of skin tears in clinical practice and research globally.

KW - Skin tear

KW - Classification

KW - ISTAP

KW - Psychometric evaluation

KW - Validity

KW - Reliability

U2 - 10.1111/bjd.18604

DO - 10.1111/bjd.18604

M3 - Review article

JO - British Journal of Dermatology

JF - British Journal of Dermatology

SN - 0007-0963

ER -