Yeung Howa, Farber Sara, Birnbaum Belinda K, Dunham Jonathan, Ogdie Alexis, Patterson Karen C, Payne Aimee S, Porteous Mary K, Rossman Milton D, Sharim Rebecca, Takeshita Junko, Werth Victoria P, Shin Daniel B, Price Sarah, Rosenbach Misha
Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Dermatol. 2015 Dec 1;151(12):1317-1322. doi: 10.1001/jamadermatol.2015.2008.
Dermatologists, pulmonologists, and rheumatologists study and treat patients with sarcoidosis with cutaneous manifestations. The validity of cutaneous sarcoidosis outcome instruments for use across medical specialties remains unknown.
To assess the reliability and validity of cutaneous sarcoidosis outcome instruments for use by dermatologists and nondermatologists treating sarcoidosis.
DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional study evaluating the use of the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI) and Sarcoidosis Activity and Severity Index (SASI) to assess cutaneous sarcoidosis disease severity and the Physician's Global Assessment (PGA) as a reference instrument. Four dermatologists, 3 pulmonologists, and 4 rheumatologists evaluated facial cutaneous sarcoidosis in 13 patients treated at a cutaneous sarcoidosis clinic in a 1-day study on October 24, 2014; data analysis was performed from November through December 2014.
Interrater and intrarater reliability and convergent validity, with correlation with quality-of-life measures as the secondary outcome.
All instruments demonstrated excellent intrarater reliability. Interrater reliability (reported as intraclass correlation coefficient [95% CI]) was good for the CSAMI Activity scale (0.69 [0.51-0.87]) and PGA (0.66 [0.47-0.85]), weak for the CSAMI Damage scale (0.26 [0.11-0.52]), and excellent for the modified Facial SASI (0.78 [0.63-0.91]). The CSAMI Activity scale and modified Facial SASI showed moderate correlations (95% CI) with the PGA (0.67 [0.57-0.75] and 0.57 [0.45-0.66], respectively). The CSAMI Activity scale but not the modified Facial SASI showed significant correlations (95% CI) with quality-of-life instruments, such as the Dermatology Life Quality Index (Spearman rank correlation, 0.70 [0.25-0.90]) and the Skin Stigma raw score of the Sarcoidosis Assessment Tool (Pearson product moment correlation, 0.56 [0.01-0.85]).
The CSAMI and SASI were reliable and valid in assessing cutaneous sarcoidosis among our diverse group of specialists. The CSAMI Activity score also correlated with quality-of-life measures and suggested construct validity. These results lend credibility to expand the use of the CSAMI and SASI by dermatologists and nondermatologists in assessing cutaneous sarcoidosis disease activity.
皮肤科医生、肺科医生和风湿科医生研究并治疗有皮肤表现的结节病患者。用于跨医学专业的皮肤结节病结局工具的有效性尚不清楚。
评估皮肤科医生和非皮肤科医生用于治疗结节病的皮肤结节病结局工具的可靠性和有效性。
设计、背景和参与者：我们进行了一项横断面研究，评估使用皮肤结节病活动和形态学工具（CSAMI）和结节病活动与严重程度指数（SASI）来评估皮肤结节病的疾病严重程度，并将医生整体评估（PGA）作为参考工具。2014年10月24日，在一天的研究中，4名皮肤科医生、3名肺科医生和4名风湿科医生对一家皮肤结节病诊所治疗的13例患者的面部皮肤结节病进行了评估；数据分析于2014年11月至12月进行。
评估评分者间和评分者内的可靠性以及收敛效度，并将与生活质量测量指标的相关性作为次要结局。
所有工具均显示出良好的评分者内可靠性。评分者间可靠性（以组内相关系数[95%CI]报告）对于CSAMI活动量表（0.69[0.51 - 0.87]）和PGA（0.66[0.47 - 0.85]）良好，对于CSAMI损伤量表（0.26[0.11 - 0.52]）较弱，对于改良面部SASI（0.78[0.63 - 0.91]）良好。CSAMI活动量表和改良面部SASI与PGA显示出中度相关性（95%CI）（分别为0.67[0.57 - 0.75]和0.57[0.45 - 0.66]）。CSAMI活动量表而非改良面部SASI与生活质量工具显示出显著相关性（95%CI），如皮肤病生活质量指数（斯皮尔曼等级相关性，0.70[0.25 - 0.90]）和结节病评估工具的皮肤耻辱感原始评分（皮尔逊积矩相关性，0.56[0.01 - 0.85]）。
在我们多样化的专家群体中，CSAMI和SASI在评估皮肤结节病方面是可靠且有效的。CSAMI活动评分也与生活质量测量指标相关，并表明具有结构效度。这些结果为皮肤科医生和非皮肤科医生在评估皮肤结节病疾病活动时扩大使用CSAMI和SASI提供了可信度。
