The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability.
BACKGROUND
There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE).


OBJECTIVE
To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.


METHODS
Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient.


RESULTS
ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment. ICC for intraobserver agreement was 0.90.


CONCLUSIONS
Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.
Held
E
E
National Allergy Research Centre and Department of Dermatology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. elisabeth-held@dadlnet.dk
Skoet
R
R
Johansen
J D
JD
Agner
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D004485:Eczema / Q000150:complications / Q000473:pathology*; D005260:Female; D006229:Hand Dermatoses / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016037:Single-Blind Method