Validation of epidemiological tools for eczema diagnosis in brazilian children: the isaac's and uk working party's criteria

Springer Science and Business Media LLC - Tập 10 - Trang 1-9 - 2010
Agostino Strina1, Mauricio L Barreto1, Sergio Cunha2, Maria de Fátima SP de Oliveira3, Shirlei C Moreira4, Hywel C Williams5, Laura C Rodrigues6
1Universidade Federal da Bahia. Instituto de Saúde Coletiva, Salvador, Brazil
2Departamento de Medicina Social, Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Recife, Brazil
3Universidade Federal da Bahia, Serviço de Dermatologia, Salvador, Brazil
4Ministério da Saúde, Núcleo Estadual da Bahia, Salvador, Brazil
5Department of Dermatology, Queen’s Medical Centre, Nottingham, UK
6London School of Hygiene and Tropical Medicine, Epidemiology and Population Health, London, UK

Tóm tắt

Instruments for field diagnosis of eczema are increasingly used, and it is essential to understand specific limitations to make best use of their strengths. Our objective was to assess the validity of ISAAC and UK Working Party criteria for field diagnosis of eczema in children. We performed a cohort study in urban Brazil. Parents/guardians of 1,419 children answered ISAAC phase II questionnaire. Children were examined for skin lesions (UKWP protocol). Two dermatologists examined most cases of eczema (according to ISAAC or UKWP), and a sample without eczema. Agreement between repeat questionnaires on the filter question was poor (kappa = 0.4). Agreement between the 2 dermatologists was fair (kappa = 0.6). False positive reports included scabies in 39% of ISAAC cases and 33% of UKWP cases. Sensitivity and PPV were low (ISAAC: 37.1% and 16.1%; UKWP: 28.6% and 23.8%). Specificity and NPV were high (ISAAC: 90.0% and 96.6%; UKWP: 95.3% and 96.2%). One-year prevalence of eczema was 11.3% (ISAAC), 5.9% (UKWP) and 4.9% (adjusted dermatologist diagnosis). Point prevalence of scabies (alone or not) was 43%, 33% and 18%, in eczemas according to ISAAC, to UKWP and to dermatologists. The reasons why children with eczema were not identified by ISAAC or UKWP were wrongly denying dry skin, itchy rash or personal history of atopic diseases. A limitation is that questionnaire was already validated in Brazil, but not field tested in this specific setting. Studies using UKWP or ISAAC criteria should include a validation arm, to contribute to the understanding of potential limitations of their use in different contexts and to explore solutions. We list specific recommendations.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-5945/10/11/prepub

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