Choi Chong Won, Kim Bo Ri, Park Jong Seo, Youn Sang Woong
Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Ann Dermatol. 2018 Jun;30(3):284-289. doi: 10.5021/ad.2018.30.3.284. Epub 2018 Apr 23.
Accurate assessment of the severity of psoriasis is important in daily practice and clinical studies. However, the assessment of psoriasis area and severity index (PASI) reflects the physician's experience, and thus evaluations by physicians are inherently subjective, with intra-rater and inter-rater variability.
To elucidate the effectiveness of PASI educational lectures and the use of reference photographs on the improvement of accuracy and reliability in PASI assessments and to develop effective educational programs for PASI assessments.
We performed a before-and-after comparison study during nation-wide PASI educational workshops. The participants were asked to assess the severity components of PASI (erythema, thickness, scale, and affected area) three times: in the test administered before an educational lecture, the test immediately after the lecture, and lastly the test with the use of reference photographs. The improvement of accuracy and reliability was analyzed by comparing the results of three tests.
Ninety-six board-certified dermatologists and residents participated and 72 participants completed all three tests. The accuracy and reliability of the assessment of severity components of PASI increased significantly after the educational lecture and the use of reference photographs. Use of reference photographs resulted in limited improvements when the recognition of three-dimensional structures was required, such as in the assessment of thickness or scale.
Our study confirmed that the combination of standardized educational training and reference photographs can improve the accuracy and reliability of PASI assessments. Understanding how to evaluate three-dimensional psoriatic lesions can help with proper assessment of the severity of psoriasis.
在日常实践和临床研究中，准确评估银屑病的严重程度至关重要。然而，银屑病面积和严重程度指数（PASI）的评估反映了医生的经验，因此医生的评估本质上是主观的，存在评分者内和评分者间的差异。
阐明PASI教育讲座和使用参考照片对提高PASI评估的准确性和可靠性的有效性，并制定有效的PASI评估教育计划。
我们在全国范围内的PASI教育研讨会上进行了一项前后比较研究。要求参与者对PASI的严重程度组成部分（红斑、厚度、鳞屑和受累面积）进行三次评估：在教育讲座前进行的测试中、讲座后立即进行的测试中，以及最后在使用参考照片的测试中。通过比较三次测试的结果来分析准确性和可靠性的提高情况。
96名获得委员会认证的皮肤科医生和住院医生参与了研究，72名参与者完成了所有三次测试。在教育讲座和使用参考照片后，PASI严重程度组成部分评估的准确性和可靠性显著提高。当需要识别三维结构时，如在评估厚度或鳞屑时，使用参考照片的改进有限。
我们的研究证实，标准化教育培训和参考照片的结合可以提高PASI评估的准确性和可靠性。了解如何评估三维银屑病皮损有助于正确评估银屑病的严重程度。
