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Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)

BACKGROUND: In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared with adults. OBJECTIVES: To test the diagnostic accuracy of previously agreed consensus criteria and to develop a shortlist of the best predictive diagnostic c...

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Autores principales: Burden‐Teh, E., Murphy, R., Gran, S., Nijsten, T., Hughes, C., Abdul‐Wahab, A., Bewley, A., Burrows, N., Darne, S., Gach, J.E., Katugampola, R., Jury, C.S., Kuet, K., Llewellyn, J., McPherson, T., Ravenscroft, J.C., Taibjee, S., Wilkinson, C., Thomas, K.S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9298773/
https://www.ncbi.nlm.nih.gov/pubmed/34477218
http://dx.doi.org/10.1111/bjd.20689
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author Burden‐Teh, E.
Murphy, R.
Gran, S.
Nijsten, T.
Hughes, C.
Abdul‐Wahab, A.
Bewley, A.
Burrows, N.
Darne, S.
Gach, J.E.
Katugampola, R.
Jury, C.S.
Kuet, K.
Llewellyn, J.
McPherson, T.
Ravenscroft, J.C.
Taibjee, S.
Wilkinson, C.
Thomas, K.S.
author_facet Burden‐Teh, E.
Murphy, R.
Gran, S.
Nijsten, T.
Hughes, C.
Abdul‐Wahab, A.
Bewley, A.
Burrows, N.
Darne, S.
Gach, J.E.
Katugampola, R.
Jury, C.S.
Kuet, K.
Llewellyn, J.
McPherson, T.
Ravenscroft, J.C.
Taibjee, S.
Wilkinson, C.
Thomas, K.S.
author_sort Burden‐Teh, E.
collection PubMed
description BACKGROUND: In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared with adults. OBJECTIVES: To test the diagnostic accuracy of previously agreed consensus criteria and to develop a shortlist of the best predictive diagnostic criteria for childhood psoriasis. METHODS: A case–control diagnostic accuracy study in 12 UK dermatology departments (2017–2019) assessed 18 clinical criteria using blinded trained investigators. Children (< 18 years) with dermatologist‐diagnosed psoriasis (cases, N = 170) or a different scaly inflammatory rash (controls, N = 160) were recruited. The best predictive criteria were identified using backward logistic regression, and internal validation was conducted using bootstrapping. RESULTS: The sensitivity of the consensus‐agreed criteria and consensus scoring algorithm was 84·6%, the specificity was 65·1% and the area under the curve (AUC) was 0·75. The seven diagnostic criteria that performed best were: (i) scale and erythema in the scalp involving the hairline, (ii) scaly erythema inside the external auditory meatus, (iii) persistent well‐demarcated erythematous rash anywhere on the body, (iv) persistent erythema in the umbilicus, (v) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees, (vi) well‐demarcated erythematous rash in the napkin area involving the crural fold and (vii) family history of psoriasis. The sensitivity of the best predictive model was 76·8%, with specificity 72·7% and AUC 0·84. The c‐statistic optimism‐adjusted shrinkage factor was 0·012. CONCLUSIONS: This study provides examination‐ and history‐based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary‐care patients. External validation is now needed.
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spelling pubmed-92987732022-07-21 Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study) Burden‐Teh, E. Murphy, R. Gran, S. Nijsten, T. Hughes, C. Abdul‐Wahab, A. Bewley, A. Burrows, N. Darne, S. Gach, J.E. Katugampola, R. Jury, C.S. Kuet, K. Llewellyn, J. McPherson, T. Ravenscroft, J.C. Taibjee, S. Wilkinson, C. Thomas, K.S. Br J Dermatol Original Articles BACKGROUND: In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared with adults. OBJECTIVES: To test the diagnostic accuracy of previously agreed consensus criteria and to develop a shortlist of the best predictive diagnostic criteria for childhood psoriasis. METHODS: A case–control diagnostic accuracy study in 12 UK dermatology departments (2017–2019) assessed 18 clinical criteria using blinded trained investigators. Children (< 18 years) with dermatologist‐diagnosed psoriasis (cases, N = 170) or a different scaly inflammatory rash (controls, N = 160) were recruited. The best predictive criteria were identified using backward logistic regression, and internal validation was conducted using bootstrapping. RESULTS: The sensitivity of the consensus‐agreed criteria and consensus scoring algorithm was 84·6%, the specificity was 65·1% and the area under the curve (AUC) was 0·75. The seven diagnostic criteria that performed best were: (i) scale and erythema in the scalp involving the hairline, (ii) scaly erythema inside the external auditory meatus, (iii) persistent well‐demarcated erythematous rash anywhere on the body, (iv) persistent erythema in the umbilicus, (v) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees, (vi) well‐demarcated erythematous rash in the napkin area involving the crural fold and (vii) family history of psoriasis. The sensitivity of the best predictive model was 76·8%, with specificity 72·7% and AUC 0·84. The c‐statistic optimism‐adjusted shrinkage factor was 0·012. CONCLUSIONS: This study provides examination‐ and history‐based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary‐care patients. External validation is now needed. John Wiley and Sons Inc. 2021-11-24 2022-02 /pmc/articles/PMC9298773/ /pubmed/34477218 http://dx.doi.org/10.1111/bjd.20689 Text en © 2021 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Burden‐Teh, E.
Murphy, R.
Gran, S.
Nijsten, T.
Hughes, C.
Abdul‐Wahab, A.
Bewley, A.
Burrows, N.
Darne, S.
Gach, J.E.
Katugampola, R.
Jury, C.S.
Kuet, K.
Llewellyn, J.
McPherson, T.
Ravenscroft, J.C.
Taibjee, S.
Wilkinson, C.
Thomas, K.S.
Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)
title Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)
title_full Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)
title_fullStr Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)
title_full_unstemmed Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)
title_short Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)
title_sort identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a uk multicentre case–control diagnostic accuracy study (dipsoc study)
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9298773/
https://www.ncbi.nlm.nih.gov/pubmed/34477218
http://dx.doi.org/10.1111/bjd.20689
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