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skin tears, classification, reliability, and validity



  1. LeBlanc, Kimberly MN, RN, CETN(C) IIWCC
  2. Baranoski, Sharon MSN, RN, CWCN, APN-CCNS, MAPWCA, FAAN
  3. Holloway, Samantha MSc, RN
  4. Langemo, Diane PhD, RN, FAAN


OBJECTIVE: The aim of this study was to validate and establish reliability of the International Skin Tear classification system.


METHOD: A consensus panel of 12 internationally recognized key opinion leaders convened in 2011 to establish consensus statements on the prevention, prediction, assessment, and treatment of skin tears. Subsequently, a new skin tear classification system was proposed. The system was then tested for interrater and intrarater reliability between the experts before being tested more widely on a sample of 327 individuals from the United States, Canada, and Europe.


RESULTS: The results of the study indicated a substantial level of agreement for the expert panel (Fleiss [kappa] = 0.619; 2-month follow-up = 0.653). Intrarater reliability was high (Cohen [kappa] = 0.877). Interrater reliability was moderate (Fleiss [kappa] = 0.555) for healthcare professionals (n = 303) and fair for non-health professionals (Fleiss [kappa] = 0.338; n = 24).


CONCLUSIONS: This international study established the reliability and validity of a new classification system for skin tears.