BACKGROUND: Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. OBJECTIVES: To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. METHODS: A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument. RESULTS: A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75). CONCLUSIONS: The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.

Centre for Medical Education School of Medicine College of Biomedical and Life Sciences Cardiff University Cardiff U K

Centre for Wounds and Wound Healing University Hospitals of Geneva Geneva Switzerland

CliniCare Medical Centre Ballito KwaZulu Natal South Africa

College of Nursing University of North Dakota Grand Forks ND U S A

Department Health Care VIVES University College Roeselare Belgium

Department of Dermatology and Allergy Charité Universitätsmedizin Berlin Berlin Germany

Department of Dermatology University of Pisa Pisa Italy

Department of Nursing Faculty of Medicine Masaryk University Brno Czech Republic

Division of Nursing Speciality Nursing Singapore General Hospital Bukit Merah Singapore

Institute of Skin Integrity and Infection Prevention Department of Nursing and Midwifery University of Huddersfield Huddersfield U K

Israeli Wound Care Management and Research Association Jerusalem Israel

Langemo and Associates Grand Forks ND U S A

Leumit HMO Vascular Ulcer Clinic Geula Jerusalem Israel

Nursing Advisory Board Rasmussen College Romeoville Joliet IL U S A

Nursing Department Ghent University Ghent Belgium

Nursing School Nursing Department Andrés Bello University Viña del Mar Chile

Research Unit of Plastic Surgery Department of Clinical Research Faculty of Health Sciences University of Southern Denmark Ødense Denmark

School of Health Sciences Örebro University Örebro Sweden

School of Medicine College of Biomedical and Life Sciences Cardiff University Cardiff U K

School of Nursing and Midwifery Monash University Melbourne VIC Australia

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

School of Nursing Faculty of Health Queensland University of Technology Brisbane QLD Australia

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

School of Nursing Faculty of Health Sciences University of the Free State Bloemfontein South Africa

School of Nursing Faculty of Health University of Canberra Canberra ACT Australia

School of Nursing Koc University Istanbul Turkey

School of Nursing Medical Surgical Nursing Department University of São Paulo São Paulo Brazil

School of Nursing Portuguese Catholic University Porto Portugal

School of Physical Therapy Faculty of Health Sciences Western University London ON Canada

Skin Integrity Research Group University Centre for Nursing and Midwifery Department of Public Health and Primary Care

Tissue Viability Unit Canberra Hospital Canberra Health Services Canberra ACT Australia

UnityPoint Health Trinity Rock Island Illinois and Bettendorf IA U S A

University Centre for Nursing and Midwifery Department of Public Health and Primary Care

Wound and Ostomy Care Reston Hospital Center Reston VA U S A

Wound Care Center

Wound Care Unit Sheikh Khalifa Medical City Abu Dhabi U A E

Wound Ostomy Continence Institute Association of Nurses Specialized in Wound Ostomy Continence Ottawa ON Canada

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Br J Dermatol. 2020 Jul;183(1):13-14. doi: 10.1111/bjd.18727. PubMed

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Medical-Grade Honey Is a Versatile Wound Care Product for the Elderly