title: Interobserver reliability of the Nail Psoriasis Severity Index.
abstract: BACKGROUND
  Because the Psoriasis Area and Severity Index (PASI) does not consider the severity of nail disease, a scale that assesses the extent of involvement of psoriatic nails is needed. A new grading system, the Nail Psoriasis Severity Index (NAPSI) has been proposed.
  
  
  OBJECTIVE
  The purpose of this study was to assess the interobserver reliability of NAPSI. Methods. The nail features of 25 patients with psoriasis with nail involvement were evaluated and graded by three dermatologists for total NAPSI scores and nail scores. The quadrants of all nails were examined for the presence of matrix and bed features. Total NAPSI score (0-160) of patients and nail score (0-32) of the individual nails were calculated. Interobserver reliability assessments were performed by computing intraclass correlation coefficients (ICC; two-way mixed model, consistency definition).
  
  
  RESULTS
  The ICC((3,1)) results for total NAPSI score and nail score were found to be 0.781 and 0.649, respectively. The ICC((3,1)) for nail-bed and nail-matrix features were 0.869 and 0.584, respectively, in the total NAPSI scoring system, and 0.705 and 0.603, respectively, in the nail scoring system.
  
  
  CONCLUSIONS
  Moderate to good agreement of scoring with the NAPSI was determined among the observers in this study. Our results suggest that scoring for nail-bed features seems to be more reliable than scoring for nail-matrix features.
authors.affiliation: Department Of Dermatology, Dokuz Eylül University School of Medicine, Izmir, Turkey. sebnem.aktan@deu.edu.tr
authors.forename: S
authors.initials: S
authors.lastname: Aktan
authors.forename: T
authors.initials: T
authors.lastname: Ilknur
authors.forename: C
authors.initials: C
authors.lastname: Akin
authors.forename: S
authors.initials: S
authors.lastname: Ozkan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000175:diagnosis* / Q000209:etiology; D015588:Observer Variation; D011565:Psoriasis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012720:Severity of Illness Index