Beattie P E, Lewis-Jones M S
Department of Dermatology, Ninewells Hospital, Dundee, UK.
Br J Dermatol. 2006 Dec;155(6):1249-55. doi: 10.1111/j.1365-2133.2006.07525.x.
Atopic dermatitis (AD) accounts for 10-20% of referrals to secondary care dermatology, often requiring multiple visits and occupying much valuable time and resources.
We audited the usefulness (ease of use, reliability and sensitivity to change) of two simple and easy to use quality of life (QoL) measures, the Infants' Dermatitis Quality of Life Index (IDQOL) and Dermatitis Family Impact (DFI), for assessing the impact on QoL of AD in infants and their families in a routine clinical setting. We also examined the impact of an initial consultation with a dermatology team on AD severity and QoL impairment from the parent's perspective.
The parents of 203 infants (mean age 19.8 months) with AD attending paediatric dermatology clinics completed the DFI and IDQOL. The parents of 50 of these infants completed both questionnaires before first and second consultations.
In the 203 children the mean of both the IDQOL and DFI scores was 8.47 (median 8 and 7 and SD 5.8 and 6.5, respectively). The IDQOL and DFI correlated well (r(s) = 0.776, P < 0.0001). The parent's assessment of the global severity of AD correlated well with the IDQOL score (r(s) = 0.636, P < 0.0001) but less well with the DFI (r(s) = 0.394, P < 0.001). The highest-scoring IDQOL items were itching and scratching, problems at bathtime and time taken to fall asleep. The highest-scoring DFI items were tiredness/exhaustion, sleep loss and emotional distress. In both measures these domains also correlated most strongly with eczema severity. After dermatology consultation the median global severity score, rated by 50 parents, fell from 2 (SD 0.83) to 1 (SD 0.8; 95% confidence interval, CI 0.5-1), the median IDQOL score fell from 8 (SD 5.92) to 5.5 (SD 5.92; 95% CI 2-5.5) and the median DFI score fell from 9 (SD 6.45) to 3 (SD 6.56; 95% CI 2-5.5). In 50 infants the median IDQOL scores for those infants with global AD severity scores of 1, 2 and 3 were 5 (SD 5.65), 8 (SD 4.27) and 14 (SD 5.67), respectively and improved by 10%, 38% and 64%, respectively while the median DFI scores improved by 54%, 56% and 79%, respectively. The most improved IDQOL items were the time taken to get to sleep and difficulty at mealtimes and the most improved DFI domains were tiredness/exhaustion and emotional distress in the parents.
We have provided further important information on the effects of AD on infants and their families using the IDQOL and DFI QoL measures. We demonstrate the usefulness of these measures in routine clinical management of AD and show the beneficial effect for both infants and parents of the initial consultation by a dermatology team in a secondary care setting.
特应性皮炎（AD）占二级皮肤科转诊病例的10%-20%，通常需要多次就诊，耗费大量宝贵时间和资源。
我们审核了两种简单易用的生活质量（QoL）评估方法，即婴儿性皮炎生活质量指数（IDQOL）和皮炎家庭影响（DFI）在常规临床环境中评估AD对婴儿及其家庭生活质量影响的实用性（易用性、可靠性及对变化的敏感性）。我们还从家长的角度研究了皮肤科团队的首次会诊对AD严重程度及生活质量损害的影响。
203名患AD的婴儿（平均年龄19.8个月）的家长在儿科皮肤科诊所完成了DFI和IDQOL评估。其中50名婴儿的家长在首次和第二次会诊前均完成了两份问卷。
在203名儿童中，IDQOL和DFI评分的平均值均为8.47（中位数分别为8和7，标准差分别为5.8和6.5）。IDQOL和DFI相关性良好（斯皮尔曼等级相关系数r(s)=0.776，P<0.0001）。家长对AD整体严重程度的评估与IDQOL评分相关性良好（r(s)=0.636，P<0.0001），但与DFI的相关性稍弱（r(s)=0.394，P<0.001）。IDQOL评分最高的项目是瘙痒和抓挠、洗澡时的问题以及入睡所需时间。DFI评分最高的项目是疲倦/疲惫、睡眠不足和情绪困扰。在这两种评估方法中，这些领域也与湿疹严重程度的相关性最强。皮肤科会诊后，50名家长评定的整体严重程度中位数评分从2（标准差0.83）降至1（标准差0.8；95%置信区间，CI 0.5-1），IDQOL中位数评分从8（标准差5.92）降至5.5（标准差5.92；95%CI 2-5.5），DFI中位数评分从9（标准差6.45）降至3（标准差6.56；95%CI 2-5.5）。在50名婴儿中，AD整体严重程度评分为1、2和3的婴儿，其IDQOL中位数评分分别为5（标准差5.65）、8（标准差4.27）和14（标准差5.67），分别改善了10%、38%和64%，而DFI中位数评分分别改善了54%、56%和79%。IDQOL改善最明显的项目是入睡所需时间和进餐困难，DFI改善最明显的领域是家长的疲倦/疲惫和情绪困扰。
我们利用IDQOL和DFI生活质量评估方法，提供了关于AD对婴儿及其家庭影响的更多重要信息。我们证明了这些评估方法在AD常规临床管理中的实用性，并显示了二级医疗机构中皮肤科团队的首次会诊对婴儿和家长均有有益效果。
