Variability in the Diagnosis of Surgical Site Infections After Full-Thickness Skin Grafting: An International Survey

Johan Palmgren, John Paoli, Artur Schmidtchen, Karim Saleh

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Diagnosis of a surgical site infection (SSI) in dermatologic surgery can be entirely based on a subjective assessment according to the 4th criterion of the most common definition of an SSI, which was established by the US Centers for Disease Control (CDC).

OBJECTIVES: To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds.

METHODS: An international electronic photographic survey with eight photographs of wounds 1 week after full-thickness skin grafting (FTSG) was sent to dermatologists. All wounds were assessed in terms of visual criteria beforehand. Data collected from respondents included physician characteristics and experience, and SSI assessments of all wounds.

RESULTS: A total of 393 dermatologists from 27 countries enrolled. Most respondents were from the United States (25%), followed by Sweden (24%) and the United Kingdom (13%). There was only a slight interobserver agreement on SSI suspicion (κ = 0·19). SSI suspicion was lower for male physicians (P = 0·03), board-certified dermatologists (P = 0·001), physicians regularly assessing surgical wounds (P = 0·03), and physicians performing FTSG (P < 0·001). Swedish physicians diagnosed more SSIs than US physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion.

CONCLUSION: This study reveals a broad inter-rater variability in the diagnosis of SSI, illustrating the need for novel objective diagnostic methods that can better capture the variables that constitute an SSI. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)1169-1175
JournalBritish Journal of Dermatology
Issue number5
Early online date2018 Dec 10
Publication statusPublished - 2019

Subject classification (UKÄ)

  • Dermatology and Venereal Diseases
  • Surgery


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