title: Issues related to accurate classification of buttocks wounds.
abstract: OBJECTIVE
  This study was designed to determine the level of agreement among wound care nurses when asked to classify the etiology of 9 wounds located on the buttocks and within the intergluteal cleft.
  
  
  METHODS
  Study subjects were 100 wound care nurses who responded to an invitation placed on the WOCN Society's wound care forum and to an e-mail sent to members of the WOCN Iowa Affiliate.
  
  
  METHODS
  Respondents were asked to view 9 unique wound photos and to determine whether the primary etiologic factor was pressure, moisture, incontinence-associated dermatitis, or skin tear. Subjects were given no background information regarding the patients but were allowed to add comments.
  
  
  RESULTS
  The overall κ analysis of the 9 photos combined was 0.1708 (99% confidence interval, 0.1630-0.1786). The testing of the overall κ for the 9 photos equaling "0" or mere chance produced a P < .0001. Analyses revealed that the agreement between the 100 respondents for the 9 photos was only 17% better than chance alone. In summary, our study revealed only "Slight Agreement" between wound care nurses' classifications of photo subgroups or for all 9 photos analyzed together.
  
  
  CONCLUSIONS
  Accurate wound classification impacts not only treatment decisions but also reimbursement, risk of litigation, and accuracy of data regarding prevalence and incidence of pressure ulcers. It is, therefore, critical for professional societies such as the WOCN to begin development of consensus definitions and guidelines to ensure consistency and accuracy in wound classification.
authors.affiliation: Iowa Health Home Care, Urbandale, Iowa, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Mahoney
authors.forename: Barbara
authors.initials: B
authors.lastname: Rozenboom
authors.forename: Dorothy
authors.initials: D
authors.lastname: Doughty
authors.forename: Hayden
authors.initials: H
authors.lastname: Smith
mesh_terms: D002081:Buttocks / Q000293:injuries*; D006801:Humans; D010781:Photography; D003668:Pressure Ulcer / Q000175:diagnosis; D014947:Wounds and Injuries / Q000145:classification / Q000451:nursing