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A protocol for recording the sign of flexural dermatitis in children
H C Williams1, H Forsdyke, G Boodoo
1St John's Institute of Dermatology, United Medical School, St Thomas' Hospital, London, U.K.
Insights
A new protocol accurately identifies flexural dermatitis, a key sign of atopic dermatitis in children. Trained non-dermatologists can use this quick, acceptable method for population studies.
Area of Science:
- Dermatology
- Epidemiology
- Pediatrics
Background:
- Atopic dermatitis diagnosis relies on identifying flexural dermatitis.
- Standardized assessment is crucial for population-based studies.
Purpose of the Study:
- To develop and validate a protocol for recording flexural dermatitis in population studies.
- To assess the reliability of the protocol when used by trained non-dermatologists.
Main Methods:
- A protocol was developed using standardized photographs and definitions of 'dermatitis' and 'flexural'.
- The protocol was tested on primary schoolchildren by a dermatologist and trained nurses.
- Inter-rater reliability was assessed using the kappa statistic.
Main Results:
- Excellent agreement (kappa=0.90) was found between a nurse and dermatologist for 73 children.
- Good agreement (kappa=0.51) was observed between two nurses for 114 children.
- The protocol is quick (<1 min), requires no undressing, and is highly acceptable.
Conclusions:
- The developed protocol is a reliable and practical tool for assessing flexural dermatitis in children.
- This method can standardize atopic dermatitis assessment in large-scale epidemiological surveys.
- Trained non-dermatologists can effectively implement this protocol.
Abstract:
The presence of visible flexural dermatitis is a key feature in diagnosing atopic dermatitis. We describe a protocol for recording this sign in population-based studies, which could be used by suitably trained non-dermatologists. The protocol was developed using a standard set of photographs and accompanying instructions, which define the terms 'dermatitis' and 'flexural'. When assessed during a survey of skin disease in primary schoolchildren, there was excellent agreement between a trained nurse and a dermatologist with regard to the presence or absence of this sign in 73 consecutive children, with perfect agreement in 71 children (97%), and a chance corrected agreement index (kappa statistic) of 0.90 (95% confidence interval [CI] 0.77-0.99). Agreement between two nurses on 114 consecutive schoolchildren was not quite as good, with perfect agreement in 102 children (90%), and a kappa value of 0.51 (95% CI 0.26-0.77). The protocol is easy to perform, does not require children to undress, takes < 1 min to carry out, and is highly acceptable to children and staff. This protocol may be useful in standardizing the assessment of atopic dermatitis in population studies of children.