评估儿科皮肤科医生、风湿病学家和神经学家在儿童皮肌炎中使用皮肤肌炎疾病面积和严重程度指数和皮肤评估工具二进制方法的可靠性。
Evaluation of the reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index and the Cutaneous Assessment Tool-Binary Method in juvenile dermatomyositis among paediatric dermatologists, rheumatologists and neurologists.
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, PA, U.S.A.
出版信息
Br J Dermatol. 2017 Oct;177(4):1086-1092. doi: 10.1111/bjd.15596. Epub 2017 Jul 31.
BACKGROUND
The Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and Cutaneous Assessment Tool-Binary Method (CAT-BM) have been shown to be reliable and valid outcome measures to assess cutaneous disease in adult dermatomyositis (DM) and juvenile DM (JDM), respectively.
OBJECTIVES
This study compared the CDASI and CAT-BM for use by paediatric dermatologists, paediatric rheumatologists and paediatric neurologists in patients with JDM.
METHODS
Five paediatric dermatologists, five paediatric rheumatologists and five paediatric neurologists each evaluated 14 patients with JDM using the CDASI, CAT-BM, and skin Physician Global Assessment (PGA) scales. Inter-rater reliability, intra-rater reliability, construct validity and completion time were compared.
RESULTS
Inter-rater reliability for CDASI activity and damage scores was good to moderate for paediatric dermatologists and rheumatologists, but poor for paediatric neurologists. The inter-rater reliability for CAT-BM activity scores was moderate for paediatric dermatologists and rheumatologists, but poor for paediatric neurologists and poor across all specialties for damage scores. Intra-rater reliability for the CDASI and CAT-BM activity and damage scores was moderate to excellent for paediatric dermatologists, rheumatologists and neurologists. Strong associations were found between skin PGA activity and damage scores and CDASI or CAT-BM activity and damage scores, respectively (P < 0·002). The CDASI had a mean completion time of 5·4 min compared with that for the CAT-BM of 3·1 min.
CONCLUSIONS
Our data confirm the reliability of the CDASI activity and damage scores and the CAT-BM activity scores when used by paediatric dermatologists and rheumatologists in assessing JDM. Significant variation existed in the paediatric neurologists' scores.
背景
皮肤肌炎疾病面积和严重程度指数（CDASI）和皮肤评估工具 - 二进制方法（CAT-BM）已被证明是可靠和有效的衡量指标，分别用于评估成人皮肌炎（DM）和青少年皮肌炎（JDM）的皮肤疾病。
目的
本研究比较了 CDASI 和 CAT-BM 在儿科皮肤科医生、儿科风湿病学家和儿科神经科医生评估 JDM 患者中的应用。
方法
5 名儿科皮肤科医生、5 名儿科风湿病学家和 5 名儿科神经科医生分别使用 CDASI、CAT-BM 和皮肤医师整体评估（PGA）量表评估 14 名 JDM 患者。比较了组内可靠性、组内可靠性、结构有效性和完成时间。
结果
对于儿科皮肤科医生和风湿病学家，CDASI 活动和损伤评分的组内可靠性为良好至中度，但对于儿科神经科医生则较差。儿科皮肤科医生和风湿病学家的 CAT-BM 活动评分的组内可靠性为中度，但对于儿科神经科医生则较差，并且对于所有专业来说，损伤评分都较差。儿科皮肤科医生、风湿病学家和神经科医生的 CDASI 和 CAT-BM 活动和损伤评分的组内可靠性为中度至极好。皮肤 PGA 活动和损伤评分与 CDASI 或 CAT-BM 活动和损伤评分之间存在很强的相关性（P<0.002）。CDASI 的平均完成时间为 5.4 分钟，而 CAT-BM 的平均完成时间为 3.1 分钟。
结论
我们的数据证实了 CDASI 活动和损伤评分以及 CAT-BM 活动评分在儿科皮肤科医生和风湿病学家评估 JDM 时的可靠性。儿科神经科医生的评分存在显著差异。
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