Reporting accuracy of pressure injury categorisation in an acute tertiary hospital : A four-year analysis

Aim
To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts.

Background
Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision-making and use of resources, and severe hospital-acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice.

Design
Secondary analysis of hospital pressure injury incident and validation data.

Methods
All pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter-rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed.

Results
Of 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter-rater agreement by category (Κ = .567, p < .001). Of those found to be non-pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated.

Conclusions
This study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate.

Relevance to Clinical Practice
These results may be used for benchmarking and provide a focal point for future education and practice improvement efforts.

Patient or Public Contribution
Neither patients nor the public were directly involved in the project.