Inter-rater reliability of three most commonly used pressure ulcer risk assessment scales in clinical practice

The objective of this study was to evaluate inter-rater reliability of Braden Scale, Norton Scale and Waterlow Scale for pressure ulcer risk assessment in clinical practice. The design of the study was cross-sectional. A total of 23 patients at pressure ulcer risk were included in the study, and 6 best registered nurses conducted three subsequent risk assessments for all included patients. They assessed alone and independently from each other. An intra-class correlation coefficient (ICC) was used to determine the inter-rater reliability. For the Braden Scale, the ICC values ranged between 0.603 (95% CI: 0.435-0.770) for the item 'moisture' and a maximum of 0.964 (95% CI: 0.936-0.982) for the item 'activity'; for the Norton Scale, the ICC values ranged between 0.595 (95% CI: 0.426-0.764) for the item 'physical condition' and a maximum of 0.975 (95% CI: 0.955-0.988) for the item 'activity'; and for the Waterlow Scale, the ICC values ranged between 0.592 (95% CI: 0.422-0.762) for the item 'skin type' and a maximum of 0.990 (95% CI: 0.982-0.995) for the item 'activity'. The ICC values of total score for three scales of were 0.955 (95% CI: 0.922-0.978), 0.967 (95% CI: 0.943-0.984), and 0.915 (95% CI: 0.855-0.958) for Braden, Norton, and Waterlow scales, respectively. Although the inter-rater reliability of Braden Scale, Norton Scale and Waterlow Scale total scores were all substantial, the reliability of some items was not so good. The items of 'moisture', 'physical condition' and 'skin type' should be paid more attention. However, some studies are needed to find out high reliable quantitative items to replace these ambiguous items in new designed scales.