Inter-observer variation in the assessment of skin ulceration

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Abstract
Six observers (three physicians and three nurses) assessed 27 wounds of different types in 20 elderly patients, using five different classification systems. Using classification by colours, inter-observer agreement was moderate when six colours were used (70% agreement, group kappa 53%), and good if this was reduced to three (80% agreement, group kappa 64%). Results were only moderate using the Shea scoring system (68% agreement, group kappa 42%). Assessment for signs of infection was fair to moderate (75-85% agreement, group kappa 29-55%), but there was high inter-observer agreement for size and area (analysis of variance, p≥0.88).

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