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A real-world accuracy of oral mucositis grading in patients undergoing hematopoietic stem cell transplantation

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Abstract

Purpose

Oral mucositis is a common complication in patients undergoing hematopoietic stem cell transplantation. Accurate oral mucositis grading is essential for both clinical practice and oral mucositis research. This study aimed to evaluate the accuracy of daily oral mucositis grading by nurses in a tertiary hospital in Australia.

Methods

A retrospective study was undertaken to review the daily patient oral assessment record, including diet, pain, erythema, ulceration and the oral mucositis grade based on World Health Organization (WHO) oral mucositis grading scale. The accuracy of the grade was determined by the observations recorded, and reasons for inaccuracy were documented. Any repetition of the same error in the same patient was noted.

Results

In total, 6841 oral assessments in 373 patients, conducted between 2017 and 2020, were reviewed. A total of 70% (N = 4781) were graded correctly. Of these, 64% (N = 3043) were grade 0. When the grade 0 scores were excluded, the accuracy of grading was reduced to 46% (N = 1738). Common reasons for incorrect grading included: unable to grade due to diet not specified, no ulceration and no pain was scored grade 1, no ulceration was scored as grade 2–4, oral intake was not taken into account, and pain without ulcer was scored 0. A total of 77% of the errors were repeated in the same patient on consecutive days.

Conclusions

Our results suggest there is frequent inaccurate evaluation of oral mucositis and a need for nurse training to accurately assess oral mucositis.

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Data availability

All data is available on request.

Code availability

Not applicable.

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Acknowledgements

We acknowledge the Royal Brisbane and Women’s Hospital Foundation for their financial support through scholarship for the principal author.

Funding

This study was conducted as a part of principal author’s Doctor of Philosophy degree. She has received a scholarship from the Royal Brisbane and Women’s Hospital Foundation.

Author information

Authors and Affiliations

  1. Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Midori Nakagaki & Karen Whitfield

  2. School of Pharmacy, University of Queensland, Brisbane, Australia

    Midori Nakagaki & Karen Whitfield

  3. Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Nicole C. Gavin & Glen A. Kennedy

  4. School of Medicine, University of Queensland, Brisbane, Australia

    Nicole C. Gavin & Glen A. Kennedy

  5. School of Nursing, Queensland University of Technology, Brisbane, Australia

    Nicole C. Gavin

  6. Faculty of Public Health, University of Queensland, Brisbane, Australia

    Alexandra Clavarino

Authors
  1. Midori Nakagaki
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  2. Nicole C. Gavin
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  3. Alexandra Clavarino
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  4. Glen A. Kennedy
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  5. Karen Whitfield
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Midori Nakagaki. The first draft of the manuscript was written by Midori Nakagaki, and all the authors commented on subsequent versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Midori Nakagaki.

Ethics declarations

Ethics approval

This study was approved by the Royal Brisbane & Women's Hospital Human Research Ethics Committee (HREC/2020/QRBW/60530) and the University of Queensland’s Human Research Ethics Committee (2020001484 / HREC/2020/QRBW/60530).

Consent to participate

As this study was a retrospective review, participants’ consent was waived. The approval to access confidential information for the purpose of research under the provision of Sect. 280 of the Public Health Act 2005 was obtained from the Director-General of Queensland Health.

Consent for publication

Not applicable as consent was waived and no patient data or individual data was included in manuscript.

Conflict of interest

The authors declare no competing interests.

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Appendix

Appendix

Table 5 Daily oral assessment sheet
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Nakagaki, M., Gavin, N.C., Clavarino, A. et al. A real-world accuracy of oral mucositis grading in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer 30, 2705–2712 (2022). https://doi.org/10.1007/s00520-021-06654-3

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  • DOI: https://doi.org/10.1007/s00520-021-06654-3

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