BACKGROUND: Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. OBJECTIVES: To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. METHODS: The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. RESULTS: The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). CONCLUSIONS: The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.

Centre for Interdisciplinary Research in Health Institute of Health Sciences Catholic University of Portugal Oporto Portugal

Clinical Research Center for Hair and Skin Science Department of Dermatology and Allergy Charité Universtitätsmedizin Berlin Berlin Germany

Department of Dermatology Ghent University Hospital Ghent Belgium

Department of Dermatology University of Pisa Pisa Italy

Department of Medicine 2 Vienna General Hospital Vienna Austria

Department of Nursing Masaryk University Faculty of Medicine Brno Czech Republic

Department of Nursing Queen's University Kingston Canada

Department of Nursing Roper Hospital Charleston SC U S A

Department of Nursing University of Valencia Valencia Spain

Department of Pediatric Surgery Division of Plastic and Maxillofacial Surgery Bambino Gesu' Children's Hospital Research Institute Rome Italy

Department of Surgery Vienna General Hospital Vienna Austria

Department of Urology University of Virginia Charlottesville VA U S A

Development of Care Barmherzige Brüder Austria Vienna Austria

Faculty of Health Sciences University of Southampton Southampton U K

Geriatric and Wound Healing Department APHP Hôpital Rothschild Paris France

Intensive Care Services Royal Brisbane and Women's Hospital and School of Nursing Queensland University of Technology Brisbane Australia

National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care University of Southampton Southampton U K

Private Universität für Medizinische Informatik und Technik und Pflegeakademie der Barmherzigen Brüder Wien Pflegewissenschaft und Gerontologie Vienna Austria

Radboud University Medical Center Radboud Institute for Health Sciences Scientific Institute for Quality of Healthcare Nijmegen the Netherlands

School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin Ireland

School of Nursing Faculty of Health Sciences Queen's University Kingston Canada

School of Nursing Koc University Istanbul Turkey

Scientific Affairs and Education Manager 3M Johannesburg South Africa

Tissue Viability Unit Canberra Hospital ACT Health Canberra Australia

University Centre for Nursing and Midwifery Department of Public Health Ghent University Ghent Belgium

University College of Southeast Norway Department of Nursing and Health Sciences Faculty of Health and Social Sciences Drammen Norway

Wond Expertise Centrum Lange Land Ziekenhuis Zoetermeer the Netherlands

Wound Care Center Ghent University Hospital Ghent Belgium

Wound Care King Saud Medical City Riyadh Saudi Arabia

Wound Clinic Sygehus Sonderjylland Sonderborg Denmark

Wound Ostomy Clinic Marion General Hospital Marion IN U S A

Br J Dermatol. 2018 Jun;178(6):1238-1239. doi: 10.1111/bjd.16651. PubMed

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