The inter-rater reliability between nurse-assessors clinically assessing infection of chronic wounds using the WUWHS criteria

Jacqueline J. H. H. M. Vestjens*, Armand A. L. M. Rondas, Richard R. J. White, Samantha S. L. Holloway

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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The aim of this study was to determine the inter-rater reliability between one expert-nurse and four clinical-nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria. A quasi-experimental design was used to collect the data. In comparison to phase 1 in which open questions' were asked, in phase 2 a pre-printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter-rater reliability of signs and symptoms was expressed by Cohens Kappa (). A substantial agreement ( 06) was considered as adequate. In both phases pocketing (p < 002), and erythema (p < 0004) scored statistically significant results. Phase 2 showed higher inter-rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect- and a perfect agreement for malodour and pain, respectively. According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre-printed form than making use of an open questions' form. To provide this with a higher level of evidence, there is need for more well conducted studies.
Original languageEnglish
Pages (from-to)8-15
Number of pages8
JournalInternational Wound Journal
Issue number1
Publication statusPublished - 1 Feb 2018


  • Chronic wounds
  • Clinical assessment
  • Inter-rater reliability
  • Wound infection
  • CARE

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