Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries.

BACKGROUND: Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized 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 multicountry 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 intrarater 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% confidence interval (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 intrarater 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 systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.

Perceptions of sexual attractiveness following ostomy surgery.

This study was conducted to obtain information regarding sexual adjustment following ostomy surgery and to explore the influence of surgery on an individual's body image. Home interviews were conducted with 40 subjects, where the mean length of time since surgery averaged 4.6 years. Retrospective perceptions of attractiveness decreased in the first year after surgery, then continued to improve with time. Most comments relative to body image during the first year after surgery had a negative connotation. Persons who saw themselves as most sexually attractive at the time of interview were most often female; however, males had seen themselves as more sexually attractive than females before surgery. Management problems significantly decreased feelings of attractiveness no matter when they occurred. Those with ileostomies who had been ill for over 10 years preoperatively tended to have enhanced feelings of attractiveness at the time of interview compared to those with other types of ostomy surgery and lengths of illness.

Partner reaction following ostomy surgery.

This study was conducted to obtain information regarding sexual adjustment following ostomy surgery and to explore the spouse/partner's reaction upon resuming sexual activities following surgery. Home interviews were conducted with 40 subjects who had a permanent stoma, where the mean length of time since surgery averaged 4.6 years. Retrospective perceptions of the spouse/partner's reactions were varied. A majority reported that their spouses reacted positively to the first sexual experience following ostomy surgery. However a substantial number of subjects stated that their sexual partner reacted with caution ("fear of hurting me") or in a negative manner. This and previous studies indicate that the sexual partner plays a key role in helping the person adjust following ostomy surgery.

Providing sexual information to ostomy patients.

Forty patients with a permanent colostomy, ileostomy, or ileal conduit were interviewed. Besides changes in sexual performance postoperatively, the authors specifically attempted to determine answers to other sexual variables such as attractiveness, appliance problems, and partner reactions. The extent of information provided to patients on sexuality prior to the permanent ostomy was also examined. There was a significant but predictable incidence of male impotence and female dyspareunia after surgery. Despite innumerable sexual variables, other than performance, which these patients faced postoperatively, 42 per cent received no information regarding sexuality at the time of ostomy surgery. most patients (97.5 per cent) stated that sexuality, including variables other than performance, should be discussed primarily by the surgeon prior to permanent ostomy surgery. The enterostomal therapist has an important role in the total patient adjustment in the long-term postoperative period.