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Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease.

Publication ,  Journal Article
Cardones, AR; Sullivan, KM; Green, C; Chao, NJ; Rowe-Nichols, K; Bañez, LL; Burton, CS; Horwitz, ME; Long, GD; Rao, CL; Sarantopoulos, S ...
Published in: JAMA Dermatol
July 1, 2019

IMPORTANCE: Cutaneous chronic graft-vs-host disease (cGVHD) is common after allogeneic hematopoietic stem cell transplant and is often associated with poor patient outcomes. A reliable and practical method for assessing disease severity and response to therapy among these patients is urgently needed. OBJECTIVE: To evaluate the interrater agreement and reliability of skin-specific and range of motion (ROM) variables of the 2014 National Institutes of Health (NIH) response criteria for cGVHD and a skin sclerosis grading scale (SSG). DESIGN, SETTING, AND PARTICIPANTS: In this observational study performed at a single tertiary academic center, 6 academic blood and marrow transplant specialists and 4 medical dermatologists examined 8 patients with diagnosed cutaneous cGVHD on July 10, 2015. The patient cohort was enriched for patients with sclerotic features. Each patient was evaluated by using the skin-specific and ROM criteria of the 2014 NIH response criteria for cGVHD and an SSG ranging from 0 to 3. Each patient was also asked to complete quality-of-life scoring instruments. Interrater agreement and reliability were estimated by calculating the Krippendorff α and Cohen κ statistics. Data were analyzed from September 29, 2015, through November 22, 2018. MAIN OUTCOMES AND MEASURES: Estimation of interrater agreement by interclass coefficient (Krippendorff α and Cohen κ statistics) for the skin-specific and ROM components of the 2014 NIH Response Criteria for Chronic GVHD and for the SSG. RESULTS: The median age of the patients evaluated was 54 years (range, 46-58 years). Patients were predominantly male (6 [75%]). Six of the 8 patients had a predominantly sclerotic cutaneous phenotype. Interrater agreement among our experts was acceptable for NIH skin feature score (0.68; 95% CI, 0.30-0.86) and good for NIH ROM scoring (0.80; 95% CI, 0.68-0.86). Dermatologists had acceptable agreement for NIH skin GVHD score (0.69; 95% CI, 0.25-0.82) and skin feature score (0.78; 95% CI, 0.17-0.98), good agreement in ROM grading (0.85; 95% CI, 0.69-0.90), and near perfect agreement in identifying sclerosis (0.82; 95% CI, 0.27-0.97). CONCLUSIONS AND RELEVANCE: Although dermatologists had acceptable agreement in NIH skin GVHD score and skin features score, near perfect agreement in identifying cutaneous sclerosis, better agreement in grading severity of cutaneous cGVHD, especially in the intermediate grades, appears to be needed.

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Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

July 1, 2019

Volume

155

Issue

7

Start / End Page

833 / 837

Location

United States

Related Subject Headings

  • Skin Diseases
  • Severity of Illness Index
  • Sclerosis
  • Reproducibility of Results
  • Quality of Life
  • Observer Variation
  • Middle Aged
  • Male
  • Humans
  • Hematopoietic Stem Cell Transplantation
 

Citation

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Cardones, A. R., Sullivan, K. M., Green, C., Chao, N. J., Rowe-Nichols, K., Bañez, L. L., … Hall, R. P. (2019). Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease. JAMA Dermatol, 155(7), 833–837. https://doi.org/10.1001/jamadermatol.2018.5459
Cardones, Adela R., Keith M. Sullivan, Cindy Green, Nelson J. Chao, Krista Rowe-Nichols, Lionel L. Bañez, Claude S. Burton, et al. “Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease.JAMA Dermatol 155, no. 7 (July 1, 2019): 833–37. https://doi.org/10.1001/jamadermatol.2018.5459.
Cardones AR, Sullivan KM, Green C, Chao NJ, Rowe-Nichols K, Bañez LL, et al. Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease. JAMA Dermatol. 2019 Jul 1;155(7):833–7.
Cardones, Adela R., et al. “Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease.JAMA Dermatol, vol. 155, no. 7, July 2019, pp. 833–37. Pubmed, doi:10.1001/jamadermatol.2018.5459.
Cardones AR, Sullivan KM, Green C, Chao NJ, Rowe-Nichols K, Bañez LL, Burton CS, Horwitz ME, Long GD, Rao CL, Sarantopoulos S, Sidhu-Malik N, Sung AD, Hall RP. Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease. JAMA Dermatol. 2019 Jul 1;155(7):833–837.

Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

July 1, 2019

Volume

155

Issue

7

Start / End Page

833 / 837

Location

United States

Related Subject Headings

  • Skin Diseases
  • Severity of Illness Index
  • Sclerosis
  • Reproducibility of Results
  • Quality of Life
  • Observer Variation
  • Middle Aged
  • Male
  • Humans
  • Hematopoietic Stem Cell Transplantation