Could Residents Adequately Assess the Severity of Hidradenitis Suppurativa? Interrater and Intrarater Reliability Assessment of Major Scoring Systems

Abstract

A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.

Serum inflammatory markers and leukocyte profiles accurately describe hidradenitis suppurativa disease severity

“…Our findings demonstrate the utility of selected inflammatory markers and leukocyte profiles as indicators of HS severity. Though measures exist for clinical assessment, including Hurley staging and HS‐PGA, there are few objective disease markers that have been exclusively investigated in cross‐sectional studies 7,13,14 . This novel longitudinal analysis validates and further emphasizes the importance of utilizing laboratory parameters for HS management.…”

The Prevalence of Periodontitis and Assessment of Oral Micro-Biota in Patients with Hidradenitis Suppurativa: A Descriptive Cross-Sectional Study

“…Detailed information on demographics, lifestyle, comorbidities, and previous treatment in both groups was collected and analyzed. HS severity stage was assessed in all patients during the dermatological evaluation using the Hurley staging system, and the clinical severity of HS was determined with International Hidradenitis Suppurativa Severity Score System (IHS4) [ 23 , 24 , 25 ].…”

Dermatological knowledge survey: US medical students’ perception of hidradenitis suppurativa

“…1,2 The prevalence of HS ranges from 0.1% to 2% and it has a higher impact on quality of life than almost all other chronic dermatological diseases, but knowledge among providers is limited and average delays to diagnosis of 5-14 years have been reported. [1][2][3] In this study, we aimed to characterize the knowledge and attitudes of US medical students toward HS in order to characterize potential deficiencies in the medical school curricula.…”

“…Interestingly, of the 97 respondents, 6 reported a personal history of HS, and 5 (2 of whom also had HS) knew family or friends with HS; these figures are higher than the reported prevalence of 0.1%-2%. [1][2][3] Our study is limited in that this represents a small proportion of US medical students. Response bias is possible as students interested in dermatology may be more likely to respond to a survey on 'dermatological conditions', but this would likely have resulted in enhanced knowledge in our cohort, yet they still demonstrated significant deficiencies.…”