Wei Wenhui, Anderson Peter, Gadkari Abhijit, Blackburn Stuart, Moon Rachel, Piercy James, Shinde Shashank, Gomez Jorge, Ghorayeb Eric
Sanofi, Bridgewater, NJ, USA.
Adelphi Real World, Bollington, UK.
Am J Clin Dermatol. 2017 Dec;18(6):825-835. doi: 10.1007/s40257-017-0284-y.
There is limited understanding of severity rating of atopic dermatitis in clinical practice.
To evaluate the agreement between physician- and patient-rated severity of atopic dermatitis.
Data were collected from the 2014 Adelphi US Atopic Dermatitis Disease Specific Programme, a cross-sectional survey of physicians and their patients with a history of moderate-to-severe atopic dermatitis; patients voluntarily completed a questionnaire. Current disease severity (mild/moderate/severe), based on personal judgment, was rated independently by patients and their physicians. The weighted kappa statistic identified level of agreement between physicians and patients. Bivariate analyses characterized agreement; multi-nomial logistic regression identified factors associated with discordance.
Overall, 678 patients were included (369 [54.4%] were women, 525 [77.4%] were White, mean age was 39.3 years). Agreement was moderate (weighted kappa = 0.52): compared with physician ratings, patient-rated severity was higher in 76 patients (11.2%), lower in 137 patients (20.2%), and matched in 465 patients (68.6%). There were no differences in the rates of agreement between physician and patient ratings based on physician specialty (p = 0.6781), objective severity measures [Eczema Area and Severity Index score (p = 0.5308), percent body surface area affected (p = 0.9872), and current systemic immunosuppressant use (p = 0.9197)]. Multivariate analysis showed patients with a worse quality of life (Dermatology Life Quality Index) were more likely to rate a higher severity (relative risk ratio 1.04, 95% confidence interval 1.00-1.08; p = 0.0460). Physicians were more likely to rate a higher severity with a greater physician-reported sleep disturbance (relative risk ratio 1.71, 95% confidence interval 1.01-2.89; p = 0.0440).
Almost one-third of patients rated atopic dermatitis severity differently from their physicians, supporting the importance of the patient perspective in the severity assessment of atopic dermatitis and the need for greater communication between patients and physicians.
在临床实践中，对特应性皮炎严重程度评级的了解有限。
评估医生评定与患者评定的特应性皮炎严重程度之间的一致性。
数据收集自2014年美国阿德尔菲特应性皮炎疾病特定项目，这是一项针对有中度至重度特应性皮炎病史的医生及其患者的横断面调查；患者自愿填写问卷。患者及其医生根据个人判断独立评定当前疾病严重程度（轻度/中度/重度）。加权kappa统计量确定医生与患者之间的一致程度。双变量分析描述一致性；多项逻辑回归确定与不一致相关的因素。
总共纳入678例患者（369例[54.4%]为女性，525例[77.4%]为白人，平均年龄39.3岁）。一致性为中等（加权kappa = 0.52）：与医生评定相比，76例患者（11.2%）的患者评定严重程度更高，137例患者（20.2%）更低，465例患者（68.6%）匹配。基于医生专业（p = 0.6781）、客观严重程度指标[湿疹面积和严重程度指数评分（p = 0.5308）、体表面积受累百分比（p = 0.9872）以及当前全身免疫抑制剂使用情况（p = 0.9197）]，医生与患者评定的一致率无差异。多变量分析显示，生活质量较差（皮肤病生活质量指数）的患者更有可能评定为更高的严重程度（相对风险比1.04，95%置信区间1.00 - 1.08；p = 0.0460）。医生报告的睡眠障碍越大，医生越有可能评定为更高的严重程度（相对风险比1.71，95%置信区间1.01 - 2.89；p = 0.0440）。
近三分之一的患者对特应性皮炎严重程度的评定与医生不同，这支持了患者视角在特应性皮炎严重程度评估中的重要性，以及患者与医生之间加强沟通的必要性。
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