Wang Li, Li Lin-Feng
Department of Dermatology, Allergy and Clinical Immunology Centre, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Chin Med J (Engl). 2016 Dec 5;129(23):2829-2833. doi: 10.4103/0366-6999.194662.
Atopic dermatitis (AD) is a common inflammatory skin disease with an increasingly significant prevalence. The prevalence of AD depends greatly on how its diagnosis is done. The UK Working Party's diagnostic criteria for AD are simple and easy to apply without invasive laboratory tests. This study assessed the clinical utility of these criteria in China.
Data were collected from 6208 patients at 31 tertiary hospitals in 13 Chinese provinces/municipalities from March 2014 to May 2014. . The agreement between the UK diagnostic criteria and the clinical records for AD was assessed by Cohen's kappa.
The overall agreement between the UK diagnostic criteria and clinical diagnosis was fair (kappa = 0.40). A slightly better agreement was found in patients aged between 4 and 9 years (kappa = 0.48), while fair agreement was found in the group <4 years and the group ≥10 years (kappa = 0.27 and 0.39, respectively). Using the UK party's criteria as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of the clinical diagnosis of AD were 62.3%, 89.2%, 38.0%, and 95.7%, respectively.
Our study indicates a modest ability among Chinese dermatologists to apply the UK Working Party's diagnostic criteria for AD, especially in patients aged <4 years and ≥10 years. Since there is no gold standard for AD diagnosis, it is important to determine how AD is identified when evaluating a diagnostic tool.
特应性皮炎(AD)是一种常见的炎症性皮肤病,其患病率日益显著。AD的患病率在很大程度上取决于其诊断方式。英国工作组的AD诊断标准简单易行,无需进行侵入性实验室检查。本研究评估了这些标准在中国的临床实用性。
收集了2014年3月至2014年5月期间来自中国13个省/直辖市31家三级医院的6208例患者的数据。通过Cohen's kappa评估英国诊断标准与AD临床记录之间的一致性。
英国诊断标准与临床诊断之间的总体一致性为中等(kappa = 0.40)。在4至9岁的患者中发现一致性稍好(kappa = 0.48),而在<4岁组和≥10岁组中发现一致性中等(分别为kappa = 0.27和0.39)。以英国工作组的标准为参照,AD临床诊断的敏感性、特异性、阳性预测值和阴性预测值分别为62.3%、89.2%、38.0%和95.7%。
我们的研究表明,中国皮肤科医生应用英国工作组AD诊断标准的能力一般,尤其是在<4岁和≥10岁的患者中。由于AD诊断没有金标准,在评估诊断工具时确定如何识别AD很重要。