Faria Joana Ribeiro Costa de, Aarão Aline Rezende, Jimenez Luiz Miguel Zabaleta, Silva Oscar Hernández, Avelleira João Carlos Regazzi
Instituto de Dermatologia Prof. Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, RJ, Brasil.
An Bras Dermatol. 2010 Sep-Oct;85(5):625-9. doi: 10.1590/s0365-05962010000500005.
Developed in 1978, the PASI (Psoriasis Area and Severity Index) is a method to rate psoriasis severity. Since then, it has been criticized for being extremely long, complex and for yielding significantly divergent interpretations.
To determine the PASI inter-rater reliability among three independent evaluators examining the same patients.
Cross-sectional study conducted in 2007 at a psoriasis treatment center, where 20 patients were selected. The patients were evaluated by three postgraduate students of Dermatology who independently determined the PASI of each patient. The inter-rater reliability coefficient was determined by employing intraclass correlation coefficients (ICC) and Bland & Altman plots.
An ICC of 0.729 (IC 95%: 0.440 - 0.882) showed a significant degree of concordance among evaluators. By graphic means, the Bland & Altman plot method presents concordance gap ranges. As shown in this study, narrow gap ranges indicate a good concordance degree. It was also observed that for high PASI values, wider concordance gap ranges predominate.
Based on this analysis, we may conclude that the PASI is a reliable indicator of psoriasis severity because it shows significant concordance when independent evaluations are performed.
银屑病面积和严重程度指数（PASI）于1978年制定，是一种评估银屑病严重程度的方法。从那时起，它就因极其冗长、复杂且产生的解释差异很大而受到批评。
确定在对同一患者进行检查的三位独立评估者之间PASI的评分者间信度。
2007年在一家银屑病治疗中心进行横断面研究，选取20例患者。由三名皮肤科研究生对患者进行评估，他们独立确定每位患者的PASI。评分者间信度系数通过组内相关系数（ICC）和布兰德-奥特曼图来确定。
ICC为0.729（95%置信区间：0.440 - 0.882），表明评估者之间存在显著程度的一致性。通过图形方法，布兰德-奥特曼图法呈现出一致性差距范围。如本研究所示，较窄的差距范围表明一致性程度良好。还观察到，对于较高的PASI值，一致性差距范围更宽。
基于此分析，我们可以得出结论，PASI是银屑病严重程度的可靠指标，因为在进行独立评估时它显示出显著的一致性。
