Interobserver Agreement of the Eczema Area and Severity Index for Atopic Dermatitis Severity Assessment: A Real-World...

Background: The Eczema Area and Severity Index (EASI) has been suggested to show a good to excellent level of concordance. However, in everyday clinical practice, there is a perceived low level of concordance.Objective: To assess the degree of concordance in the EASI scores in a real-world clinical setting.Methods: This transversal study assesses interobserver concordance of EASI among 5 evaluators between January and October 2024.Results: For the head and neck area, unacceptable concordance was found for all the items in EASI. In the trunk area, there was acceptable concordance for the affected surface area (0.686 [95% confidence interval {CI}: 0.539-0.799]) but unacceptable concordance for the other items. For the upper and lower extremities, unacceptable concordance was observed for all items. The total EASI interclass correlation coefficient showed moderate concordance (0.754 [95% CI: 0.659-0.838]). Despite moderate concordance for the total EASI score, the median EASI range for the same patient was 13, indicating significant heterogeneity between evaluators.Discussion and Conclusion: This study highlights the variability of the EASI in the evaluation of atopic dermatitis (AD) in a real-world clinical practice setting, suggesting that patient-reported outcome measures and experiences should be given more importance as additional AD severity measures.