Skin colour assessment of replanted fingers in digital images and its reliability for the incorporation of images in nursing progress notes

Aims and objectives To determine whether nurses can accurately assess the skin colour of replanted fingers displayed as digital images on a computer screen. Background Colour measurement and clinical diagnostic methods for medical digital images have been studied, but reproducing skin colour on a computer screen remains difficult. Design The inter‐rater reliability of skin colour assessment scores was evaluated. In May 2014, 21 nurses who worked on a trauma ward in Japan participated in testing. Methods Six digital images with different skin colours were used. Colours were scored from both digital images and direct patient's observation. The score from a digital image was defined as the test score, and its difference from the direct assessment score as the difference score. Intraclass correlation coefficients were calculated. Nurses’ opinions were classified and summarised. Results The intraclass correlation coefficients for the test scores were fair. Although the intraclass correlation coefficients for the difference scores were poor, they improved to good when three images that might have contributed to poor reliability were excluded. Most nurses stated that it is difficult to assess skin colour in digital images; they did not think it could be a substitute for direct visual assessment. However, most nurses were in favour of including images in nursing progress notes. Discussion Although the inter‐rater reliability was fairly high, the reliability of colour reproduction in digital images as indicated by the difference scores was poor. Nevertheless, nurses expect the incorporation of digital images in nursing progress notes to be useful. This gap between the reliability of digital colour reproduction and nurses’ expectations towards it must be addressed. Conclusions High inter‐rater reliability for digital images in nursing progress notes was not observed. Assessments of future improvements in colour reproduction technologies are required. Relevance to clinical practice Further digitisation and visualisation of nursing records might pose challenges.