Reliability of subjective wound assessment

Abstract

Introduction Assessment of the take of split-skin graft and the rate of epithelialisation are important parameters in burn surgery. Such parameters are normally estimated by the clinician in a bedside procedure. This study investigates whether this subjective assessment is reliable for graft take and wound epithelialisation. Methods Observers involved in the field of burns (experienced, medium-experienced and inexperienced observers), and dermatologists specialized in the field of wound healing evaluated the percentage graft take and epithelialisation in 50 photographic skin-grafted burn wounds. Reliability was tested using the intraclass correlation coefficient (ICC). Results Intra- and interobserver reliability of parameter graft take was highest within the experienced observers (ICC average > 0.91), followed by medium- and inexperienced observers (ICC average > 0.80 and ICC average > 0.68). Parameter epithelialisation showed the same pattern of intra- and interobserver ICC scores (experienced > medium > inexperienced). Interobserver ICC single scores of the experienced group were reasonable to good. Interobserver reliability of the dermatologists was similar to medium-experienced observers. Conclusions Our data show that one experienced observer can obtain adequate reliable results by means of a single assessment of graft take and epithelialisation. Furthermore, experience of the observer results in an increase of reliability.