皮肤科医生、风湿病学家和神经科医生对皮肤型皮肌炎疾病面积和严重程度指数（CDASI）的可靠性。
The reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) among dermatologists, rheumatologists and neurologists.
作者信息
Tiao J, Feng R, Bird S, Choi J K, Dunham J, George M, Gonzalez-Rivera T C, Kaufman J L, Khan N, Luo J J, Micheletti R, Payne A S, Price R, Quinn C, Rubin A I, Sreih A G, Thomas P, Okawa J, Werth V P
机构信息
Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A.
出版信息
Br J Dermatol. 2017 Feb;176(2):423-430. doi: 10.1111/bjd.15140. Epub 2016 Dec 22.
BACKGROUND
Previous studies have shown that skin disease in dermatomyositis (DM) is best assessed using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). Although the CDASI has been validated for use by dermatologists, it has not been validated for use by other physicians such as rheumatologists and neurologists, who also manage patients with DM and assess skin activity in clinical trials.
OBJECTIVES
To assess the reliability of the CDASI among dermatologists, rheumatologists and neurologists.
METHODS
Fifteen patients with cutaneous DM were assessed using the CDASI and the Physician Global Assessment (PGA) by five dermatologists, five rheumatologists and five neurologists.
RESULTS
The mean CDASI activity scores for dermatologists, rheumatologists and neurologists were 21·0, 21·8 and 20·8, respectively. These mean scores were not different among the specialists. The CDASI damage score means for dermatologists, rheumatologists and neurologists were 5·3, 7·0 and 4·8, respectively. The mean scores between dermatologists and rheumatologists were significantly different, but the means between dermatologists and neurologists were not. The intraclass correlation coefficients (ICCs) for interrater reliability for CDASI activity and damage were good to excellent for dermatologists and rheumatologists, and moderate to excellent for neurologists. The ICCs for intrarater reliability for CDASI activity and damage were excellent for dermatologists and rheumatologists and moderate to excellent for neurologists. The PGA displayed lower interrater and intrarater reliability relative to the CDASI.
CONCLUSIONS
Our results confirm the reliability of the CDASI when used by dermatologists and rheumatologists. The data for its use by neurologists were not as robust.
背景
既往研究表明，使用皮肌炎皮肤疾病面积和严重程度指数（CDASI）能最好地评估皮肌炎（DM）的皮肤病变。尽管CDASI已被证实可供皮肤科医生使用，但尚未在其他医生（如风湿病学家和神经科医生）中得到验证，而这些医生也负责管理皮肌炎患者并在临床试验中评估皮肤活动情况。
目的
评估CDASI在皮肤科医生、风湿病学家和神经科医生中的可靠性。
方法
由5名皮肤科医生、5名风湿病学家和5名神经科医生使用CDASI和医生整体评估（PGA）对15例皮肤型DM患者进行评估。
结果
皮肤科医生、风湿病学家和神经科医生的CDASI活动评分均值分别为21.0、21.8和20.8。这些均值在各专科医生之间无差异。皮肤科医生、风湿病学家和神经科医生的CDASI损伤评分均值分别为5.3、7.0和4.8。皮肤科医生和风湿病学家之间的均值有显著差异，但皮肤科医生和神经科医生之间的均值无差异。CDASI活动和损伤的评分者间信度组内相关系数（ICC），皮肤科医生和风湿病学家为良好至优秀，神经科医生为中等至优秀。CDASI活动和损伤的评分者内信度ICC，皮肤科医生和风湿病学家为优秀，神经科医生为中等至优秀。相对于CDASI，PGA显示出较低的评分者间和评分者内信度。
结论
我们的结果证实了CDASI在皮肤科医生和风湿病学家使用时的可靠性。神经科医生使用CDASI的数据则没那么可靠。
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