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A pilot comparison study of four clinician‐rated atopic dermatitis severity scales
Author(s) -
Zhao C.Y.,
Tran A.Q.T.,
LazoDizon J.P.,
Kim J.,
Daniel B.S.,
Venugopal S.S.,
Rhodes L.M.,
Law M.G.,
Murrell D.F.
Publication year - 2015
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.13846
Subject(s) - atopic dermatitis , medicine , dermatology
Summary Background There are multiple severity outcome measures for atopic dermatitis ( AD ). There is a need to compare the reliability of these measures. Objectives To compare the inter‐rater and intrarater reliability of the objective Scoring Atopic Dermatitis ( oSCORAD ), Eczema Area and Severity Index ( EASI ), Six Area, Six Sign Atopic Dermatitis ( SASSAD ) and Three Item Severity index ( TIS ); and to analyse the correlation between these outcome measures and the quality‐of‐life instruments Patient‐Orientated Eczema Measurement, Dermatology Life Quality Index and Skindex‐29. Methods Twelve patients with AD attended a 1‐day scoring exercise by five trained dermatology clinicians. Inter‐rater and intrarater reliability were assessed using the intraclass correlation coefficient ( ICC ). Correlation between clinician‐rated and patient‐reported measures was analysed using Spearman's rho. Results Regarding inter‐rater reliability, EASI and SASSAD showed good reliabilities, with ICC s of 0·730 [95% confidence interval ( CI ) 0·500–0·900] and 0·680 (95% CI 0·440–0·880), respectively. However, the ICC s were poor for TIS and oSCORAD , with 0·497 (95% CI 0·233–0·785) and 0·498 (95% CI 0·234–0·785), respectively. Separate body surface area ( BSA ) component analyses showed that the oSCORAD BSA component contributed to its inter‐rater variations. Regarding intrarater reliability, EASI and TIS showed excellent ICC s of 0·886 (95% CI 0·744–0·952) and 0·820 (0·614–0·923), respectively, while SASSAD showed a good reliability with an ICC of 0·720 (95% CI 0·424–0·878). However, the intrarater ICC was poor for oSCORAD , with 0·446 (95% CI 0·037–0·730). Regarding correlation with patient‐reported measures, only SASSAD demonstrated moderate correlation with Skindex‐29 (ρ = 0·611, P = 0·035). Conclusions EASI demonstrated the highest inter‐rater and intrarater reliability, supporting it as the optimal AD severity outcome measure.