Interrater reliability of the Glamorgan Scale: overt and covert data Jane Willock ulcers are painful, and if severe may need repeated skin grafting (Matsumura et al, 1995). Infection in these ulcers is not uncommon (Brook, 1991), and can spread to other tissues including bone, resulting in osteomyelitis (Dubey et al, 1988; Bar-On et al, 2002).

The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale (Glamorgan scale) had been developed using statistical analysis of patient data. The aim of this study was to assess the reliability of the Glamorgan scale using overt and covert methods. Method For the overt data collection, randomly selected trained nursing staff were invited to participate. Twenty-seven trained nursing staff assessed 27 children and young people within 10 minutes of an assessment by the researcher. For the covert part of the data collection the researcher and the paediatric tissue viability (TV) link nurse risk assessed inpatients on wards and units where the overt data collection had taken place, their findings were compared with the last recorded assessment by the clinical nurses. Results In the overt data collection 24 out of 27 nurses agreed with the researcher (88.9% agreement, kappa 0.867). In the covert data collection, 41 out of 55 risk assessments had been completed. Of the 41 completed assessments 34 agreed with the researcher and tissue viability link nurse (82.9% agreement, kappa 0.763). Conclusion The level of agreement was good for overt and covert interrater reliability data.

Eleven published paediatric PU ulcer risk-assessment tools have been identified. Of these, six were developed from adult PU risk-assessment tools (Bedi, 1993; Quigley and Curley, 1996; Garvin, 1997; Huffines and Logsdon, 1997; Pickersgill, 1997; Suddaby et al, 2005), two appeared to have been developed from clinical experience (Olding and Patterson, 1998; McGurk et al, 2004), one was developed from a literature review (Cockett, 1998), and two were developed using patient data (Waterlow, 1998; Willock et al, 2007). The tool developed by Waterlow (1998) (Paediatric Pressure Sore/Skin Damage Risk Assessment Form) is not predictive, but gives advice on management of factors associated with pressure ulcer development.

Key words: Children ■ Pressure ulcer risk assessment ■ Glamorgan scale ■ Interrater reliability ■ Overt data

The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale (Glamorgan Scale)

Covert data


search of CINAHL from January 2000 to December 2012 using the text words ‘pressure ulcer’ yielded 9335 hits. When this was combined with ‘child or infant or adolescent’ the number of hits fell to 1352. Although the problem of pressure ulcers (PUs) in children does not appear to get the attention that PUs in adults receives, prevalence in the general paediatric population has been reported to be as high as 27.7% (Schluer et al, 2009). PUs in children can leave scars, these are particularly distressing and obvious on the head as hair fails to re-grow, resulting in scarring alopecia (Gershan and Esterly, 1993; Kumar and Kumar, 1993) which may not have resolved years after the initial insult (Neidig et al, 1989). Detrimental changes in body image can make children withdrawn and have a negative effect on socialisation and education (Kozierowski, 1996). Pressure

Jane Willock is Senior Lecturer at the University of South Wales, Pontypridd, and Clinical Nurse Specialist in Children’s Rheumatology at the Children’s Hospital for Wales, Cardiff Accepted for publication: September 2013


Paediatric risk-assessment tools

The Glamorgan scale (Willock et al, 2007; 2009) was developed using detailed data of patient characteristics from an incidence study (82 patients) and a prevalence study (183 patients) in one children’s hospital in the UK, and a multicentre study in 11 hospitals in the UK (71 patients), with ethical approval. The incidence and prevalence studies generated data reflecting the characteristics of a general population of inpatient children. The multicentre data were predominantly from children with pressure ulcers. The total combined data set consisted of 61 children with pressure ulcers and 275 children with no observed pressure ulcers.The ages of patients ranged from 1 day to 17 years and 11 months. Chi square analysis indicated characteristics of paediatric patients that were associated with PU development; all significant (p2 seconds/cool mottled skin)


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Interrater reliability of the Glamorgan scale: overt and covert data.

The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale (Glamorgan scale) had been developed using statistical analysis of patient data. The aim...
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