title: Is the red-yellow-black scheme suitable to classify donor site wounds? An inter-observer analysis.
abstract: BACKGROUND
  The red-yellow-black-scheme (RYB) is a well-known and validated scheme to classify chronic and acute wounds, based on wound color and moistness. We investigated whether this RYB-scheme is also useful to classify donor site wounds uniformly (DSW).
  
  
  METHODS
  Twenty-three digital photographs of DSWs in various stages of wound healing were presented to internationally renowned wound scientists (n=11), surgical doctors (n=31), specialized wound nurses (n=55), and surgical nurses (n=28). These observers classified the color and moistness of the wound according to the RYB-scheme, yielding seven wound categories. Inter-observer agreement (IOA) was expressed as a kappa (κ) value.
  
  
  RESULTS
  IOA's among specialized wound nurses were moderate when based on wound color and moistness (κ=0.41; 95% CI 0.33-0.49), wound color only (κ=0.41; 95% CI 0.29-0.53), or moistness only (κ=0.54; 95% CI 0.45-0.64). However, these IOA's tended to be better than those among the scientists, doctors and nurses. Scientists showed the lowest agreement (k-values between 0.17 and 0.25). Doctors scored slightly better than nurses.
  
  
  CONCLUSIONS
  Clinicians and scientists have difficulty with classifying DSWs by means of the RYB-scheme. Therefore, this scheme does not appear useful to classify donor site wounds in a uniform manner.
authors.affiliation: Quality Assurance & Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Eskes
authors.forename: Louise A A
authors.initials: LA
authors.lastname: Gerbens
authors.forename: Chantal M A M
authors.initials: CM
authors.lastname: van der Horst
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
mesh_terms: D000328:Adult; D003116:Color; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography; D014945:Wound Healing; D014947:Wounds and Injuries / Q000145:classification* / Q000473:pathology