Concordance Between Physician-rated and Caregiver-perceived Disease Severity in Children with Atopic Dermatitis: A Cross-sectional Study

Abstract

This study reveals discordance between caregiver-reported and physician-rated severity of childhood atopic dermatitis (AD). Physicians and parents value different aspect in assessing severity of AD. This study examined the measures from a real-life perspective. The results also show that caregivers may have a better understanding of severity, given that they see the child on a daily basis. Physicians should therefore work in partnership with caregivers to encourage adherence to treatments. This information sheds light on when parental understanding of severity is differently understood, which is an important step in improving adherence to treatment recommendations.This study examined concordance between caregiverreported and physician-rated estimates of severity of atopic dermatitis (AD) in paediatric patients and explored potential explanatory factors. Physician-reported severity of AD was retrieved from medical records, while caregiver-reported disease severity and sociodemographic data were obtained through a survey that also collected information on out-of-pocket expenses due to AD. There was 38.5% (95% confidence interval (95% CI) 30.1, 43.5) disagreement between physician and caregivers with regards to both underestimating and overestimating the condition. A duration since AD diagnosis shorter than 6 months showed higher concordance (kappa: 44.4%; 95% CI 30.6, 58.2) between caregiver and physician estimates of AD severity compared with a duration of 6 months or longer. Care givers underestimating their child's AD accounted for 27.7% among all participants, while 10.8% overestimated the severity of AD compared with physicians. Factors significantly associated with caregiver's under estimation of disease severity were age of the child and time since disease diagnosis. Comparison of concordance between caregiver-reported and physicianrated estimates of severity of AD in paediatric patients revealed a tendency amongst caregivers to underestimate severity of AD. This information may have clinical implications for treatment outcomes if caregivers fail to adhere to medical advice.

Implications of Atopic Dermatitis on the Quality of Life of 6–11 Years Old Children and Caregivers (PEDI-BURDEN)

“…46 Twenty-seven percent of caregivers underestimated the severity of their children's disease whereas in another study, AD was underestimated by parents in 37.1% of cases compared to adolescent patient's self-assessment. 46,47 Drawing a conclusion, our study is consistent with the results from previous scientific literature linking AD to psychosocial functioning: itch-induced sleep deprivation seems to be one of the major triggers of physical and mental exhaustion which result in emotional distress, impaired concentration and poor daily performance. 48 Furthermore AD, like other pediatric dermatologic disorders, can undermine self-esteem and the willingness to go to school and spend time with peers.…”

“… 46 Twenty-seven percent of caregivers underestimated the severity of their children’s disease whereas in another study, AD was underestimated by parents in 37.1% of cases compared to adolescent patient’s self-assessment. 46 , 47 …”

Atopic Dermatitis Patients’ Preference on Patient Self-administered Tools Used in Clinical Practice

“…The ADCT tool implied that AD was uncontrolled in 67% vs 44% by self-estimation. Patient underestimation compared with treating physicians’ assessments has previously been reported in a US-based adult patient population ( 6 ) and in a Singapore-based paediatric population ( 7 ). This underestimation might result from adjusting to a long-term disease often affecting the patient since infancy.…”