A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability

Abstract

This paper reports on the development and testing of a tool designed to assess chronic wounds for the clinical signs and symptoms of localized infection. Thirty-one wounds were assessed by two independent nurse observers for the signs and symptoms of infection using the Clinical Signs and Symptoms Checklist. The Clinical Signs and Symptoms Checklist delineates 12 signs and symptoms of infection (i.e., pain, erythema, edema, heat, purulent exudate, serous exudate with concurrent inflammation, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the wound, foul odor, and wound breakdown) and their definitions. The reliability of each sign or symptom on the checklist was calculated using percent agreement and the Kappa statistic. Percent agreement ranged from 65% to 100%, and Kappa statistics ranged from 0.53 to 1.00, excluding pocketing of the wound base. The reliability estimates obtained for signs and symptoms on the Clinical Signs and Symptoms Checklist compare favorably with other data regarding interclinician agreement on wound assessment. Incorporating a structured approach to assess and monitor for wound infection, such as the Clinical Signs and Symptoms Checklist, may improve clinician skill and accuracy in identifying this condition.