Journal Reading - Alergi
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Journal Reading of Allergyand Immunology Sub Dept
Patient-OrientedSCORAD (PO-
SCORAD): a new self-
assessment scale in
atopic dermatitis
validated in Europe
Stalder et al
Allergy 66(2011):1114-1121
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IntroductionChronic/relapsing
pruritic inflammatoryskin disease
Dry skin
Significant impactQOL
Public health cost
Industrialized CountriesChildren : 10 20%
Adults : 1 3%
ATOPICDERMATITIS
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Introduction
Severity +management
ETFAD (1992)
SCORAD
(efficacy tx)
CharacteristicAD is not
similar each
course
Assessmentby doctorinsufficient
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Introduction
SELFASSESSMENT
SCALE
Bettermonitoring
An effectivecommunication
tool
Require greaterpatients
involvement
SA-EASI ratingscale, Skin
Detective scale,ADQ, POEM
scale
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Introduction
Subjective
symptoms
Objectivesymptoms
PO-SCORAD
SAS by ETFAD
To validate this scale in a large European population of adults and children
To assess the consistency between SCORAD PO-SCORAD
To confirm PO-SCORAD is quick and easy
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Patients and MethodsProspective,
observationalstudy
Feb 09 Jan2010
Belgium,Denmark,
Finland, France,Germany, Italy,
the Netherlands,Sweden,
Switzerland
The protocol was
validated byindependentscientific (ETFAD)
Informed Consent
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Subjects and Procedures
Adults (> 18 yo) children (< 18 yo)
understand and complete thePO-SCORAD questionnaire
Disease severity : D0 and D28
Evaluation based on the same items, objective and subjective symptoms:1. Surface area of skin affected by eczema in the last 3 days2. Dryness of the skin without eczema3. Evaluation of the severity of the eczema over the last 3 days (redness of
skin affected by eczema, swelling, oozing/crust, scratching and thickening),
4. Pruritus and sleep loss
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Evaluation Criteria and plan ofAnalysis
Consistency between PO-SCORAD and SCORAD,
coefficient correlation > 0.7 with a lower limit of CI 95% >
0.65
Main criteria : correlation between PO-SCORAD and SCORADindexes at D0 for overall population
The consistency between 2 scales was evaluated :
Correlation between 2 scales indexes at D28 for all
populationD28, time period D0 D28 > 21 days and 21 days and < 35 days
The same correlations were also determined for adults
and children subgroups
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Statistical Analysis SAS software (9.13 ver, pack 4, SAS Institute Inc., Cary, NC,
USA)
Quantitative data : number of patients, missing data, meanand standard deviation, min-max.
Between group comparison : Students t-test/Wilcoxon ranksum test (nonparametric)
Qualitative data : available data, missing data, totalnumbers, percentage
Comparison adults-children : Chi-square test/exact Fishertest
Correlation PO-SCORAD SCORAD at D0 and D28 : Bravais-Pearson correlation coefficient
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Resuts
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Discussion
Validating the ability of PO-SCORAD to self-assess ADseverity
Confirming the results in pilot study in a large population(75% mild-moderate, 25% severe)
PO-SCORAD and SCORAD were well correlated
At D0 : correlation at D0 was good, lower than that assumedin design of the protocol
Post hoc analysis : both D0 and D28, the correlation betweenSCORAD and PO-SCORAD at D0 was higher [r=0.71 (95%CI:0.64;0.75), p
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Discussion 2nd evaluation: correlation coefficient 0.79
Learning by doing
High correlation between absolute changes
from baseline SCORAD and PO-SCORADPO-SCORAD assess AD accurately
A valuable tool for doctor gives good estimate
of AD severity
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Discussion Present study had correlation much stronger
>> previous study
Visual explanation
PO-SCORAD is easy and feasible
No significant difference between PO-SCORAD
and SCORAD according to age
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DiscussionPO-
SCORAD
Subjective +objective
Symptomspictures
POEMscale
Adequatelyvalidated
subjectiveoutcome
SA-EASI
Itscounterpartfor doctor
Difficult forpatient
ADQ
Poorassessment
tool
SkinDetective
Scale
Similarwith PO-SCORAD
Difficult forchildren