title: [Differentiation between moisture lesions and pressure ulcers using photographs in a critical area].
abstract: OBJECTIVE
  To identify difficulties for nurses in differentiating between moisture lesions and pressure ulcers, proper classification of pressure ulcers to assess the adequate classification of the Grupo Nacional para el Estudio y Asesoramiento de Úlceras por Presión y Heridas Crónicas (GNEAUPP) and the degree of agreement in the correct assessment by type and category of injury.
  
  
  METHODS
  Cross-sectional study in a critical area during 2014. All nurses who agreed to participate were included. They performed a questionnaire with 14 photographs validated by experts of moisture lesions or pressure ulcers in the sacral area and buttocks, with 6 possible answers: Pressure ulcer category I, II, III, IV, moisture lesions and unknown. Demographics and knowledge of the classification system of the pressure ulcers were collected according to GNEAUPP.
  
  
  RESULTS
  It involved 98% of the population (n=56); 98.2% knew the classification system of the GNEAUPP; 35.2% of moisture lesions were considered as pressure ulcers, most of them as a category II (18.9%). The 14.8% of the pressure ulcers photographs were identified as moisture lesions and 16.1% were classified in another category. The agreement between nurses earned a global Kappa index of .38 (95% CI: .29-.57).
  
  
  CONCLUSIONS
  There are difficulties differentiating between pressure ulcers and moisture lesions, especially within initial categories. Nurses have the perception they know the pressure ulcers classification, but they do not classify them correctly. The degree of concordance in the diagnosis of skin lesions was low.
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España. Electronic address: finavalls@gmail.com.
authors.forename: Josefa
authors.initials: J
authors.lastname: Valls-Matarín
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Del Cotillo-Fuente
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España.
authors.forename: María
authors.initials: M
authors.lastname: Pujol-Vila
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Ribal-Prior
authors.affiliation: Área de Críticos, Hospital Universitari Mútua Terrassa Terrassa, Barcelona, España.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Sandalinas-Mulero
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D009726:Nurses; D010781:Photography; D003668:Pressure Ulcer / Q000175:diagnosis*; D011795:Surveys and Questionnaires
keywords: Conocimientos, actitudes y práctica en salud; Critical care; Cuidados intensivos; Enfermería; Fotografía; Health knowledge, attitudes practice; Lesiones por humedad; Moisture lesions; Nursing; Photography; Pressure ulcer; Úlceras por presión