Silman A, Harrison M, Brennan P
Arthritis and Rheumatism Council Epidemiology Research Unit, University of Manchester, UK.
J Rheumatol. 1995 Jul;22(7):1277-80.
A total skin thickness score based on summating the numerical severity grade at a specific number of skin sites is a widely accepted method of disease assessment in scleroderma. Our aim was to simplify the modified Rodnan skin thickness score (grade 0-3 at 17 sites) by either (1) reducing the number of grades or (2) reducing the number of sites, and to increase agreement without losing precision.
Eight patients were examined in random order by 16 experienced clinicians using the modified Rodnan method. The data were analyzed to determine (1) whether there was an improvement in agreement by reducing severity grades to a 0-2 scale, (2) whether the precision of the score could be maintained by using a reduced number of sites.
Collapsing adjacent grades from the 0-3 scale to generate 3 new 0-2 scales performed similarly (intraclass correlation coefficients 0.66-0.72). A regression analysis showed that 95% of the variance in skin score can be predicted by inclusion of scores from just 5 sites: forearms, lower legs, anterior chest, upper arms, and fingers.
A simpler skin score may be useful in clinical studies depending on the precision required.
基于特定数量皮肤部位的数值严重程度分级总和得出的全皮肤厚度评分，是硬皮病疾病评估中一种广泛接受的方法。我们的目标是通过以下两种方式简化改良的罗德南皮肤厚度评分（17个部位，分级为0 - 3级）：（1）减少分级数量；（2）减少部位数量，并在不损失精度的情况下提高一致性。
16名经验丰富的临床医生按照随机顺序，使用改良的罗德南方法对8名患者进行检查。对数据进行分析，以确定：（1）将严重程度分级简化为0 - 2级是否能提高一致性；（2）使用较少数量的部位能否保持评分的精度。
将0 - 3级中的相邻分级合并以生成3个新的0 - 2级，其表现相似（组内相关系数为0.66 - 0.72）。回归分析表明，仅纳入前臂、小腿、前胸、上臂和手指这5个部位的评分，就能预测皮肤评分中95%的方差。
根据所需精度，更简单的皮肤评分在临床研究中可能有用。
