title: Interrater agreement, reliability and validity of the Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale.
abstract: OBJECTIVE
  To determine (1) What is the degree of interrater agreement and reliability of Glamorgan scale item and sum scores? and (2) Are Glamorgan scale sum scores valid?
  
  
  BACKGROUND
  Pressure ulcer risk assessment scales are recommended for use in clinical practice. For paediatric patients, 12 instruments are currently described. Empirical evidence about the performance of Glamorgan scale scores in clinical practice is limited.
  
  
  METHODS
  An observational validation study was conducted on a paediatric cardiac unit of a large university hospital in Germany in April and May 2010.
  
  
  METHODS
  Children were assessed simultaneously and independently by varying convenience samples of three nurses per assessment situation. Pressure ulcer risk was measured by the Glamorgan scale and a 100 mm Visual Analogue Scale (VAS). Proportions of agreement (po ), multirater kappa and intraclass correlation coefficients were calculated.
  
  
  RESULTS
  Thirty children were rated by 27 nurses. Median children's age was 5·5 years. Agreement among item scores was high, whereas reliability coefficients of item scores were low. Interrater reliability for the Glamorgan scale sum scores was higher than for VAS scores. Correlation between both scales was moderate.
  
  
  CONCLUSIONS
  High agreement among item scores indicates that nurses are able to make precise judgements. The low interrater reliability of item and sum scores indicates that nurses were unable to differentiate the rated children based on their item and sum scores, thus providing little additional clinical relevant information about pressure ulcer risk in this setting.
  
  
  CONCLUSIONS
  The Glamorgan scale and the VAS are unable to make clear distinctions in a low-risk setting. Therefore, it is unlikely that the tools in this setting provide additional information for clinical decision making. Both tools are not recommended for daily use.
authors.affiliation: Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kottner
authors.forename: Martina
authors.initials: M
authors.lastname: Kenzler
authors.forename: Doris
authors.initials: D
authors.lastname: Wilborn
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D015588:Observer Variation; D003668:Pressure Ulcer / Q000453:epidemiology*; D018570:Risk Assessment
keywords: agreement; child; infant; nursing; pressure ulcer; reliability; reproducibility; validity