Evaluation of the SACS instrument for use in Pediatrics

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 reliability and validity of the Studio Alterazioni Cutanee Stomali (SACS™) instrument, when used in pediatrics. Content validity was previously assessed in adults; this study extends that work.

Data collection included questionnaire, direct observation, and rating of lesion photographs. There were 73 skin lesions in 65 children, with 292 direct observations and 40 photographs. Participants were 64 parents, 64 bedside nurses, and 10 wound nurses, who simultaneously assessed the child's skin lesion.

The instrument was feasible for use by parents and nurses. Most parents (98%) were willing to use the instrument at home. Intra-rater reliability was acceptable (78-85% agreement for clinically-relevant lesion severity categories). There was strong evidence of inter-rater reliability, with intraclass correlation > 0.91. 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, and differently than wound experts. 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.

Limitations included single setting, limited number of wound nurses, and convenience sampling. Strengths included standardized methodology and strong basis in the theoretical framework. Findings supported SACS™ instrument use in pediatrics to document peristomal skin lesions; providing a standardized assessment that could  facilitate clinical decisions and communication.