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September 1990

Classification of Pressure Ulcers

Author Affiliations

From the Rehabilitation Institute of Chicago (Drs Yarkony, Carlson, Roth, Heinemann, Lee, and Betts, and Mss Kirk, Lovell, and King), and the Department of Rehabilitation Medicine, Northwestern University Medical School, Chicago, Ill (Drs Yarkony, Roth, Lee, and Betts).

Arch Dermatol. 1990;126(9):1218-1219. doi:10.1001/archderm.1990.01670330098016

• Several systems exist for classifying pressure ulcers, though none of them have been evaluated for interrater reliability. A new grading scale was compared with the commonly used Shea classification. This new scale was developed to provide a more complete description of pressure ulcer healing. The advantages of this scale include a classification of red areas as ulcers to help prevent further deterioration and classification of healed sores to note potential problems. The Yarkony-Kirk scale classifies a red area as a grade 1 ulcer, and involvement of the epidermis and dermis with no subcutaneous fat observed as a grade 2 ulcer. Grade 3 indicates exposed subcutaneous fat with no muscle observed. Exposed muscle without bone involvement is classified as a grade 4 ulcer, and grade 5 describes exposed bone with no joint space involvement. Grade 6 indicates joint space involvement. There is a classification of pressure sore healed to indicate a healed pressure ulcer. Interrater reliability was assessed by two nurses. In spite of an increased number of categories for the Yarkony-Kirk scale, there was no decline in reliability. Reliability was excellent with an interrater correlation of 0.90 for the Yarkony-Kirk scale and 0.86 for the Shea classification when measured for 72 patients. Eighty-five percent of the ratings for the Yarkony-Kirk scale were identical, whereas only 68% were identical for the Shea classification. Three percent of the ratings for the Shea classification were greater than ± 1 category; 6% of the ratings for the Yarkony-Kirk scale were greater than ± 1 category. This scale appears to possess good reliability and to describe pressure ulcers more completely. This scale may also be used to teach prevention activities as well as ulcer classification.

(Arch Dermatol. 1990;126:1218-1219)