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Reliability assessment and validation of the dermal pigmentation area and severity index: a new scoring method for
M S Kumaran1, G Dabas1, K Vinay1
1Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Background:
Dermal pigmentation area and severity score (DPASI) is a recently proposed scoring system for acquired dermal macular hyperpigmentation (ADMH).
Objective:
To determine the reliability and validity of DPASI.
Methods:
After standardized training, three researchers independently rated 55 patients with ADMH on two consecutive days within 1 week, to determine intra-rater and inter-rater reliability. Validation was performed by comparing DPASI with the physician global assessment score.
Results:
Test-retest reliability of individual raters tested by Pearson's r showed good correlation for all three raters (r = 0.984, P < 0.0001; r = 0.983, P < 0.000 and r = 0.970, P < 0.0001). Inter-rater agreement computed by intra-class correlation coefficient also showed good correlation (ICC = 0.997, P < 0.0001). Internal consistency as measured by Cronbach's alpha was 0.997. The score faired well in face and content validity (I-CVI of 0.87). On usability assessment, the scale had a median score of 4 on a scale from 1 to 5. The meantime taken to score the patients were 307.2 ± 83, 308.9 ± 84.4, 350.15 ± 91.8 s by three observers, respectively.
Conclusion:
The DPASI is a reliable measure of ADMH severity. The use of dermoscopy decreases inter and intra-observer variation resulting in a more objective score.
Insights
The Dermal Pigmentation Area and Severity Score (DPASI) is a reliable tool for assessing acquired dermal macular hyperpigmentation (ADMH). Its use, especially with dermoscopy, enhances objectivity and reduces observer variation in clinical practice.
Area of Science:
- Dermatology
- Clinical Assessment Tools
- Hyperpigmentation Disorders
Background:
- Acquired dermal macular hyperpigmentation (ADMH) presents a clinical challenge in objective assessment.
- The Dermal Pigmentation Area and Severity Score (DPASI) is a novel system designed to quantify ADMH.
- Standardized and validated scoring systems are crucial for clinical research and patient management.
Purpose of the Study:
- To rigorously evaluate the reliability and validity of the Dermal Pigmentation Area and Severity Score (DPASI).
- To establish DPASI as a dependable instrument for measuring ADMH severity.
- To assess the impact of dermoscopy on the objectivity of DPASI scoring.
Main Methods:
- Fifty-five patients diagnosed with ADMH were independently assessed by three researchers over two days.
- Intra-rater and inter-rater reliability were determined using statistical measures like Pearson's r and ICC.
- Face, content validity, and usability were assessed, alongside validation against physician global assessment scores.
Main Results:
- DPASI demonstrated excellent test-retest reliability (Pearson's r > 0.97) and inter-rater agreement (ICC = 0.997).
- High internal consistency (Cronbach's alpha = 0.997) and strong face/content validity (I-CVI = 0.87) were observed.
- The scoring process was efficient, with a median usability score of 4/5 and average completion times around 5-6 minutes.
Conclusions:
- The DPASI is a highly reliable and valid scoring system for assessing the severity of acquired dermal macular hyperpigmentation.
- The integration of dermoscopy significantly minimizes observer variability, leading to a more objective and reproducible ADMH assessment.
- DPASI offers a practical and effective tool for clinicians and researchers managing ADMH.
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