DET score, instrument, measurement, ostomy care, peristomal skin, reliability, ruler, stoma, usability



  1. Yang, Hui MM, RN, WT
  2. Zhao, Xinyue RN, WOCN
  3. Yang, Qing PhD
  4. Jiang, Qinghua RN


OBJECTIVE: To evaluate the usability of a novel instrument (stoma ruler) to measure damaged peristomal skin in patients with an ostomy.


METHODS: A wound ostomy and continence nurse used both the stoma ruler and a linear ruler to assess DET (discoloration, erosion, tissue overgrowth) scores and the height of protrusion above the skin of 10 patients with ileostomies and took photographs. The photographs were presented to five ostomy care nurses for reliability testing. The difference between the two methods was determined using paired Wilcoxon signed ranks test.


PRIMARY OUTCOME MEASURE: Interrater reliability of the linear versus stoma ruler.


RESULTS: The interrater reliabilities of the stoma ruler versus the linear ruler for the domain-area DET score were 0.95 (95% confidence interval, 0.89-0.99) and 0.68 (95% confidence interval, 0.42-0.89), respectively. Only nurse 5 reported a significant difference between the two rulers (z = -2.24, P = .03).


CONCLUSIONS: In busy clinical settings, the stoma ruler is easy for ostomy care nurses to use to obtain accurate DET scores and the height of stoma protrusion above the skin. Observing the position of damaged skin using the clock marks on the stoma ruler enhance clinical description and reduce assessment variation among professionals.