Excellent Agreement Between Dermatology and Pediatric Researchers In Severity Scoring Of Atopic Dermatitis (SCORAD) Index In Children

The Severity Scoring of Atopic Dermatitis (SCORAD) index is a widely applied instrument for assessing atopic dermatitis severity. Although SCORAD has been validated in several studies, few have evaluated the interobserver agreement between different disciplines. Twenty-one children with atopic dermatitis (AD) were recruited. Each was evaluated using SCORAD by: three dermatologists, two pediatricians and a pediatric nurse. All pediatric researchers were trained in SCORAD by a dermatologist. Severity of AD according to SCORAD was classified in mild (<25), moderate (25-50) or severe (>50). Inter-observer agreement was evaluated using the intraclass correlation coefficient (ICC). Nine patients were male (43%), mean age was 2 years (range 0-15). Mean SCORAD was 24.7 (range 5.5-46.8); 11 patients had mild (52%), 7 patients had moderate (33%) and 3 patients had severe AD (14%). ICC among the 6 observers was 0.91 (95%CI 0.84-0.96). There was an excellent agreement between dermatologists and non-dermatologists in SCORAD (ICC = 0.95, 95%CI 0.88-0.98), objective SCORAD (ICC = 0.92, 95%CI 0.80-0.97) and three-item severity score (ICC = 0.85, 95%CI 0.67-0.94). Interobserver agreement did not change significantly by age or gender of patients. ICC for each SCORAD item had moderate agreement for erythema 0.56 (95%CI 0.37-0.74), lichenification 0.51 (95%CI 0.33-0.71), and dryness 0.47 (95%CI 0.29-0.68), and substantial agreement for edema/papulation 0.63 (95%CI 0.45-0.79), oozing/crust 0.67 (95%CI 0.50-0.82), excoriation 0.68 (95%CI 0.52-0.83), and extension 0.77 (95%CI 0.63-0.88). SCORAD training leads to an excellent agreement between dermatology and pediatric researchers. Our work supports training for standardizing SCORAD scoring between researchers from different disciplines.