Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries

BEECKMAN, D., K. VAN DEN BUSSCHE, P. ALVES, Arnold M.C. LONG, H. BEELE, G. CIPRANDI, F. COYER, T. de GROOT, D. DE MEYER, E. DESCHEPPER, A.M. DUNK, A. FOURIE, P. GARCIA-MOLINA, M. GRAY, A. IBLASI, R. JELNES, E. JOHANSEN, A. KARADAG, K. LEBLANC, Z.K. DADARA, S. MEAUME, Andrea POKORNÁ, M. ROMANELLI, S. RUPPERT, L. SCHOONHOVEN, S. SMET, C. SMITH, A. STEININGER, M. STOCKMAYR, N. VAN DAMME, D. VOEGELI, A. VAN HECKE, S. VERHAEGHE, K. WOO and J. KOTTNER. Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries. British Journal of Dermatology. Hoboken: Wiley-Blackwell, 2018, vol. 178, No 6, p. 1331-1340. ISSN 0007-0963. Available from: https://dx.doi.org/10.1111/bjd.16327.

Basic information

• Original name: Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries
• Authors: BEECKMAN, D. (56 Belgium, guarantor), K. VAN DEN BUSSCHE (56 Belgium), P. ALVES (620 Portugal), Arnold M.C. LONG (840 United States of America), H. BEELE (56 Belgium), G. CIPRANDI (380 Italy), F. COYER (36 Australia), T. de GROOT (528 Netherlands), D. DE MEYER (56 Belgium), E. DESCHEPPER (56 Belgium), A.M. DUNK (36 Australia), A. FOURIE (710 South Africa), P. GARCIA-MOLINA (724 Spain), M. GRAY (840 United States of America), A. IBLASI (682 Saudi Arabia), R. JELNES (208 Denmark), E. JOHANSEN (578 Norway), A. KARADAG (792 Turkey), K. LEBLANC (124 Canada), Z.K. DADARA (40 Austria), S. MEAUME (250 France), Andrea POKORNÁ (203 Czech Republic, belonging to the institution), M. ROMANELLI (380 Italy), S. RUPPERT (40 Austria), L. SCHOONHOVEN (826 United Kingdom of Great Britain and Northern Ireland), S. SMET (840 United States of America), C. SMITH (40 Austria), A. STEININGER (40 Austria), M. STOCKMAYR (40 Austria), N. VAN DAMME (56 Belgium), D. VOEGELI (826 United Kingdom of Great Britain and Northern Ireland), A. VAN HECKE (56 Belgium), S. VERHAEGHE (56 Belgium), K. WOO (124 Canada) and J. KOTTNER (56 Belgium).
• Edition: British Journal of Dermatology, Hoboken, Wiley-Blackwell, 2018, 0007-0963.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30216 Dermatology and venereal diseases
• Country of publisher: United States of America
• Confidentiality degree: is not subject to a state or trade secret
• Impact factor: Impact factor: 6.714
• RIV identification code: RIV/00216224:14110/18:00103951
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1111/bjd.16327
• UT WoS: 000435078600118
• Keywords in English: Incontinence-associated dermatitis
• Tags: 14110611, rivok
• Tags: International impact, Reviewed

Abstract

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. What's already known about this topic? Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis in adults with incontinence. Ten IAD severity categorization instruments have been developed, some of which have been found to be time-consuming and (linguistically) complex when used in clinical practice. A universal IAD classification system is needed to guide practice, inform educational platforms and support research. What does this study add? The Ghent Global IAD Categorization Tool is based on input from international experts and was psychometrically tested by 823 healthcare professionals from 30 countries. The accuracy of differentiating between a diagnosis of erythema vs. skin loss was high when IAD was classified based on images. The identification of clinical signs of infection can be prone to error.