Article

Digital photographs are often used in treatment monitoring for home care of less
advanced pressure ulcers. We investigated assessment agreement when stage III and
IV pressure ulcers in individuals with spinal cord injury were evaluated in
person and with the use of digital photographs. Two wound-care nurses assessed 31
wounds among 15 participants. One nurse assessed all wounds in person, while the
other used digital photographs. Twenty-four wound description categories were
applied in the nurses' assessments. Kappa statistics were calculated to
investigate agreement beyond chance (p < or = 0.05). For 10 randomly selected
"double-rated wounds," both nurses applied both assessment methods. Fewer
categories were evaluated for the double-rated wounds, because some categories
were chosen infrequently and agreement could not be measured. Interrater
agreement with the two methods was observed for 12 of the 24 categories (50.0%).
However, of the 12 categories with agreement beyond chance, agreement was only
"slight" (kappa = 0-0.20) or "fair" (kappa = 0.21-0.40) for 6 categories. The
highest agreement was found for the presence of undermining (kappa = 0.853, p <
0.001). Interrater agreement was similar to intramethod agreement (41.2% of the
categories demonstrated agreement beyond chance) for the nurses' in-person
assessment of the double-rated wounds. The moderate agreement observed may be
attributed to variation in subjective perception of qualitative wound
characteristics.

Langue : ANGLAIS