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An Index for Staging the Severity of Cutaneous Inflammatory Disease

Holly B. Faust, MD; René Gonin, PhD; Tsu-Yi Chuang, MD, MPH; Charles W. Lewis, MD; Catherine A. Melfi, PhD; Evan R. Farmer, MD

Arch Dermatol. 1997;133(11):1443-1448.

Abstract
Objectives
To describe a new severity of illness index for inflammatory skin disease called the Dermatology Index of Disease Severity (DIDS), and to show its preliminary use and reliability in staging disease in patients with psoriasis and dermatitis.

Design
Interobserver rating study using the DIDS with as many as 10 observers independently rating the same patient at a single point in time.

Setting
Ambulatory care clinics at an academic medical center with patients from various socioeconomic backgrounds.

Patients
Thirty-four patients with psoriasis and 15 patients with dermatitis were included in the study.

Main Outcome Measures
The severity of illness for each patient was rated as 1 of 5 stages: 0, no evidence of clinical disease; I, limited disease; II, mild disease; III, moderate disease; and IV, severe disease. The degree of interobserver concordance was measured by the Cohen statistic.

Results
All 5 stages were represented in the study of patients with psoriasis. The overall statistic was 0.76, which is defined as substantial interobserver concordance. The use of the instrument in dermatitis showed good consensus in staging, where the statistic was 0.41.

Conclusion
We introduce an easy and efficient instrument for staging the severity of illness in inflammatory cutaneous diseases. The reliability of the DIDS is demonstrated in patients with psoriasis and in patients with dermatitis.

Arch Dermatol. 1997;133:1443-1448

Author Affiliations
From the Departments of Dermatology (Drs Faust, Gonin, Chuang, Lewis, and Farmer) and Medicine (Drs Faust, Gonin, and Melfi), Indiana University Medical Center, and The Roudebush Veterans Affairs Medical Center (Dr Chuang), Indianapolis, Ind.

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