An inter-assessor reliability study on the categorization and staging of pressure injuries

Abstract

Background: The first step in effective management of pressure injuries (PIs) is to assess, categorize and stage correctly. Purpose: This study aims to examine the agreement regarding the classification and staging of PIs among nurse academicians working on chronic wounds and with different stage of expertise. Methods: Three nurse academicians were assigned as assessors according to Benner's stages of clinical competence (Competent, Proficient, and Expert). The assessors independently evaluated PIs photographs (n = 694). The assessors then met for the wounds where there was disagreement, and a Consensus agreement was reached. Kappa Statistics analysed the agreement between two assessors;Fleiss Kappa Statistics analysed the agreement between Competent, Proficient, Expert, and Consensus. Results: Statistically, almost perfect agreement was obtained between Competent, Proficient, Expert, and Consensus assessments, respectively (Ƙ = 0.871;p < 0.001, Ƙ = 0.842;p < 0.001, Ƙ = 0.937;p < 0.001). The highest agreement between the assessors were Unstageable PIs, Deep Tissue PIs, and Stage 3 PIs respectively. The most common disagreements were between Deep Tissue PIs and Stage 1 PIs, and between Deep Tissue PIs and Stage 2 PIs. Conclusion: In the study, it was found that the categorization, and staging of PIs had varying degrees of reliability among the assesors, although at a statistically acceptable level.