title: Assessment of atopic dermatitis using self-report and caregiver report: a multicentre validation study.
abstract: BACKGROUND
  The epidemiology of atopic dermatitis (AD) in the U.S.A. has been described largely via US population-based questionnaire studies. However, the validity of the questions used for self- and caregiver-reported eczema has not been previously demonstrated.
  
  
  OBJECTIVE
  To validate the assessment of self- and caregiver-reported eczema.
  
  
  METHODS
  We performed a prospective multicentre dermatology-practice-based study (three sites) to determine the validity of caregiver- and self-reported ever having eczema and 1-year history of eczema. Questionnaires were administered to unselected patients prior to their encounter. Patients (n = 782) were then evaluated by expert dermatologists trained in utilizing the Hanifin and Rajka criteria for AD. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were determined.
  
  
  RESULTS
  Caregiver-reported 1-year history of childhood eczema was found to have a sensitivity (95% confidence interval) of 0·70 (0·59-0·80), specificity of 0·96 (0·93-0·99) and PPV of 0·87 (0·78-0·96) when compared with a physician's diagnosis of AD at that visit. Similarly, self-reported 1-year history of adult eczema was found to have a sensitivity of 0·70 (0·59-0·80), specificity of 0·95 (0·93-0·97) and PPV of 0·76 (0·64-0·85). The specificities and PPVs of a history of ever having caregiver- (0·89, 0·82-0·96 and 0·81, 0·70-0·93) and self-reported eczema (0·97, 0·95-0·99 and 0·91, 0·85-0·97) were high, with a high sensitivity in children (0·83, 0·72-0·95) but not in adults (0·43, 0·37-0·51).
  
  
  CONCLUSIONS
  Self- and caregiver-reported diagnosis of eczema ever or in the past year based on a single question demonstrates sufficient validity for the epidemiological study of AD.
authors.affiliation: Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.|Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A.
authors.forename: J I
authors.initials: JI
authors.lastname: Silverberg
authors.affiliation: Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.
authors.forename: S
authors.initials: S
authors.lastname: Immaneni
authors.affiliation: Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A.
authors.forename: B
authors.initials: B
authors.lastname: Rusniak
authors.affiliation: Department of Dermatology, Mount Sinai St Luke's-Roosevelt Hospital and Beth Israel Medical Centers, New York, NY, U.S.A.
authors.forename: N B
authors.initials: NB
authors.lastname: Silverberg
authors.affiliation: Department of Dermatology, Mount Sinai St Luke's-Roosevelt Hospital and Beth Israel Medical Centers, New York, NY, U.S.A.
authors.forename: R
authors.initials: R
authors.lastname: Debashis
authors.affiliation: Department of Dermatology, Oregon Health Science University, Portland, OR, U.S.A.
authors.forename: N
authors.initials: N
authors.lastname: Fewkes
authors.affiliation: Department of Dermatology, Oregon Health Science University, Portland, OR, U.S.A.
authors.forename: E L
authors.initials: EL
authors.lastname: Simpson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000592:standards*; D002648:Child; D003876:Dermatitis, Atopic / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008487:Medical History Taking / Q000592:standards; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D057566:Self Report / Q000592:standards*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D055815:Young Adult