| Description |
Peristomal skin lesions are common following stoma surgery. However, there is wide variability in how those lesions are documented. The purpose of this study was to evaluate psychometric properties and feasibility of use for the Studio Alterazioni Cutanee Stomali (SACS™) instrument. Content validity was previously evaluated. This study extends that work by examining use in pediatrics, use by parents and bedside nurses, and by evaluating reliability and validity. The study was guided by the Donabedian Structure-Process-Outcome framework and psychometric theory. Data collection included questionnaire, direct observation, and rating of lesion photographs. Participants were 64 parents of children who had undergone stoma surgery, 64 bedside nurses, and 10 wound nurses, who simultaneously assessed the child's skin lesion. There were 73 lesions in 65 children, with 292 direct observations and 40 photographs. Findings supported use of the SACS™ instrument in pediatrics. The instrument was feasible for parent and nurse use. Most parents (98%) were willing to use the instrument at home. Intrarater reliability was acceptable when ratings were grouped into clinically relevant categories (78-85% agreement for lesion severity). There was strong evidence of interrater reliability, with intraclass correlation > 0.91. The contrasted groups approach supported construct validity, demonstrating that the instrument could distinguish between lesions of known severity, and that parents and bedside nurses, who have less stoma experience, rate lesions in a similar manner to each other, and differently than wound experts. Most important clinically, there was strong evidence of decision validity; the instrument was able to discriminate between lesions that needed to be seen in clinic and those that could be safely treated at home. When there was disagreement, raters consistently erred on the side of safety, rating lesions as more severe than the expert, which would have resulted in the child being assessed by a clinician. Limitations included a single setting with limited number of wound nurses, convenience sampling, and predominantly Caucasian population. Strengths included standardized methodology and strong basis in the theoretical framework. The study demonstrated that the instrument can be used in the pediatric population to document peristomal skin lesions, which should facilitate clinical decisions and communication. |
