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classification, ISTAP, Italian, skin tears, translation, validation, wounds



  1. Bassola, Barbara MSc, RN
  2. Ceci, Paolo RN
  3. Lolli, Angela MSc, RN
  4. LeBlanc, Kimberly PhD, RN, WOCN, CET(D)
  5. Lusignani, Maura MSc, RN


OBJECTIVE: To validate the International Skin Tear Advisory Panel (ISTAP) Classification System in Italian.


METHODS: In collaboration with the ISTAP, the classification system was translated into Italian using a forward-back translation process. To validate the translated system, a convenience sample of 212 health professionals classified 30 photographs of skin tears originally used by ISTAP. The wound images were labeled type 1, 2, or 3 as described by the classification system. The resulting scores were compared with the ISTAP classification, and the reliability of agreement was calculated with Fleiss [kappa].


RESULTS: Complete data were obtained from 209 healthcare professionals. When the image classifications were compared with the original ISTAP indications, 72.5% of all classifications were correct. Data indicated a moderate level of agreement (Fleiss [kappa] = 0.466, range = 0.41-0.60). Data analysis showed similar agreement levels between nurses (n = 197, Fleiss [kappa] = 0.466) and nonnurses (n = 12, Fleiss [kappa] = 0.46).


CONCLUSIONS: The study validates the Italian version of the ISTAP skin tear classification system. Further studies are necessary to confirm the system's usability in Italian research and clinical settings.