What happens to the severity grading by objective SCORAD if we over‐ or underestimate disease extent or intensity in patients with atopic dermatitis?

Hon, Kam‐Lun Ellis; Wang, Shuxin Susan; Leung, Ting Fan

doi:10.1111/j.1365-4632.2011.05004.x

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…This shows that the estimation of intensity signs contributed to inter-rater variability of the oSCORAD more than the estimation of disease extent. This may be confirmed by the results of a study performed by Hon et al [21] , which revealed that misestimation of AD intensity, rather than the disease extent, would tremendously alter the severity grading of oSCORAD. Thus, careful assessment of disease intensity is of paramount concern in order to minimize the effect of misestimation.…”

Section: Discussionsupporting

confidence: 76%

Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA

Bożek

Reich²

2017

Dermatology

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Background: Numerous different scoring systems have been proposed for assessing the severity of atopic dermatitis (AD). Many of these methods did not undergo proper validation and reliability testing. Objective: The aim of our study was to compare the reliability and reproducibility of the Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), and Investigator Global Assessment (IGA). Methods: On the scoring day, 10 trained dermatologists evaluated 10 adult patients with AD using the EASI, oSCORAD, and IGA. All subjects were assessed twice by each physician. Correlations between measures were analysed using the Pearson correlation coefficient. The intra-class correlation coefficient (ICC) was calculated to assess intra-rater reliability; the coefficient of variation (CV) was used to assess inter-rater variability. Results: Significant positive correlations were observed between each scale in both assessments. The ICCs for the EASI and oSCORAD were 0.71 and 0.66, respectively, indicating good reliability, while the ICC for the IGA (0.54) indicated only fair reliability. The CVs for the oSCORAD and IGA were 28.1 and 33.0, respectively, indicating moderate variability. The CV for the EASI was 66.5, indicating high variability. Conclusion: Among the 3 compared scales, the oSCORAD had the highest inter-rater reliability, whereas the EASI had the highest intra-rater reliability. None of the 3 scoring methods showed a significant advantage over the other. Thus, a reliable assessment of AD severity requires the use of at least 2 independent measurements simultaneously.

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Section: Discussionsupporting

confidence: 76%

Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA

Bożek

Reich²

2017

Dermatology

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“…Patients with severe AD start with higher disease severity and often show less fluctuations, allowing for greater differences in treatment responses. [23][24][25][26][27] The sensitivity of clinical outcome measures generally increases with higher baseline disease activity and shows less reproducibility with lower scores, [23][24][25][26][27] a fact that is now increasingly recognized in trial design.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of fezakinumab (an IL-22 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by conventional treatments: A randomized, double-blind, phase 2a trial

Guttman‐Yassky

Brunner

Neumann

et al. 2018

Journal of the American Academy of Dermatology

282

189

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“…Although SCORAD is a good instrument for AD, it was also used to be the measurement of efficacy and patient’s condition in the trials of Complementary or Alternative Medicine (CAM) domain, such as Traditional Korean Medicine, TCM and homoeopathic treatment for AD[19-21], however, a huge difference, especially if underestimated in the mild group, would occur if intensity is misestimated when using the SCORAD; Surrogate markers of disease severity could overcome or supplement shortcoming of clinical scores in AD research [22]. As there are no other validated instruments for AD patients in TCM area, we believe that this instrument may be useful in daily clinical practice and scientific research, especially in the area of Complementary or Alternative Medicine (CAM).…”

Section: Discussionmentioning

confidence: 99%

Development and initial validation of a traditional Chinese medicine symptom-specific outcome measure: a Zheng-related atopic dermatitis symptom questionnaire (ZRADSQ)

Huang

et al. 2013

Health Qual Life Outcomes

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BackgroundZheng represents pattern differentiation in Traditional Chinese Medicine (TCM), as the basic unit and a key concept in TCM therapeutic theory, is based on the physiology and pathology of TCM. None of the outcome measurements of atopic dermatitis (AD) are Zheng-specific. The effectiveness of TCM is likely to be underestimated without a Zheng-related symptom-specific instrument. The aim of this study was to develop an instrument for measuring the Zheng-related symptom-specific status of patients with AD.MethodsWe followed standard methodology to develop the instrument, including item generation and selection, item reduction and presentation, and pretesting, and recruited 188 patients with AD involved in a six-center randomized-controlled trial (ChiCTR-TRC-08000156) to validate the questionnaire. We conducted construct validity, reliability, and responsiveness analysis. The standardized effect size (SES) and standardized response mean (SRM) were used to calculate the responsiveness of additional items and the total score for the rating items.ResultsZRADSQ has 15 items, with 12 rating items and 3 additional items. The 12 rating items fall within three domains: AD symptoms (n = 6 items); Heat (n = 4 items) and Mood (n = 2 items). Confirmatory factor analysis provided good support for a three-factor model (d.f. = 51, x2=97.11, RMSEA = 0.07, CFI = 0.96), and the Pearson’s correlation coefficient between ZRADSQ and Severity Scoring of Atopic Dermatitis (SCORAD) was 0.40 (P < 0.001). The reliability was also good, with a Cronbach’s alpha value for ZRADSQ of 0.84, a split-half coefficient of 0.75, and a test-retest reliability coefficient of 0.98. The standardized effect size and standardized response mean were close to or larger than 1, which indicated moderate to good responsiveness.ConclusionsThe ZRADSQ demonstrates promising reliability, validity, and responsiveness. It can be used to determine whether Zheng-specific or symptom-specific treatments relieve the symptom that is most bothersome the patient.

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What happens to the severity grading by objective SCORAD if we over‐ or underestimate disease extent or intensity in patients with atopic dermatitis?

Cited by 8 publications

References 20 publications

Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA

Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA

Efficacy and safety of fezakinumab (an IL-22 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by conventional treatments: A randomized, double-blind, phase 2a trial

Development and initial validation of a traditional Chinese medicine symptom-specific outcome measure: a Zheng-related atopic dermatitis symptom questionnaire (ZRADSQ)

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