title: Performance characteristics of the venous clinical severity score.
abstract: OBJECTIVE
  To facilitate study of the natural history and management of venous disease, a 10-component venous clinical severity (VCS) score has been proposed as an objective measure of disease severity. The purpose of this study was to evaluate the validity and reliability of this instrument.
  
  
  METHODS
  VCS component scores (0 to 3) for pain, varicose veins, edema, pigmentation, inflammation, induration, stocking use, and ulcer size, duration, and number were measured in consecutive patients with chronic venous disease. Differences between observers (n = 3) and on serial evaluation by the same observer were determined.
  
  
  RESULTS
  One hundred twenty-eight limbs in 64 patients were evaluated. Mean VCS score increased from CEAP class 0 (1.7 +/- 1.8) to class 6 (14.7 +/- 3.0; R =.84; P <.0001). Scores in 68 limbs evaluated twice by the same observer differed by a mean of only 0.8 (P =.15), with a reliability coefficient of 0.6. Mean scores of 8.0 (+/- 5.1), 7.2 (+/- 5.1), and 8.0 (+/- 5.4) were obtained in 63 limbs evaluated by all three investigators (P =.02). Only the component scores for pain, inflammation, and pigmentation showed significant (P <.05) interobserver variability. Interobserver agreement on the absence of disease or presence of severe disease as defined by scores of 3 or less or 8 or more was good (kappa = 0.59 and 0.65, respectively).
  
  
  CONCLUSIONS
  The VCS score is a critically needed tool for evaluating changes in venous disease over time. The score is reliable and shows good correlation with CEAP clinical classification.
authors.affiliation: Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle 98195, USA. meissner@u.washington.edu
authors.forename: Mark H
authors.initials: MH
authors.lastname: Meissner
authors.forename: Cynthia
authors.initials: C
authors.lastname: Natiello
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Nicholls
mesh_terms: D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014652:Vascular Diseases / Q000175:diagnosis*