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The Severity-Weighted Assessment Tool (SWAT)

Seth R. Stevens, MD; Malcolm S. Ke, MD; Eileen J. Parry, MD; Julie Mark, MD; Kevin D. Cooper, MD

Arch Dermatol. 2002;138:42-48.

Objective  To develop a quantitative tool to assess severity of mycosis fungoides.

Design  Prospective analysis of a cohort.

Setting  University department of dermatology–based cutaneous lymphoma clinic.

Patients  From 1984 to 1995, 1186 visits from 323 referred patients seen in a multidisciplinary cutaneous lymphoma program.

Main Outcome Measures  Severity-weighted assessment tool (SWAT) scores were obtained for patients at each visit. This score represents the product of the percentage total body surface area (%TBSA) involvement of each lesion type (patch, plaque, and tumor or ulceration), multiplied by a weighting factor: SWAT = (patch %TBSA x 1) + (plaque %TBSA x 2) + (tumor or ulcer %TBSA x 3). In addition, the standard measurements of TBSA involvement and physician global assessments were recorded for comparison.

Results  The SWAT score correlated well with %TBSA (r = 0.95, P<.001), physician global assessment (r = 0.60, P<.001), and time to complete remission during psoralen–UV-A therapy (r = 0.80, P<.001), therefore indicating validity against standard measures. Analysis of individual and subsets of patients demonstrated that the SWAT score more accurately quantified changes in skin disease burden, including mixed responses to treatment, than did %TBSA alone.

Conclusions  The SWAT score is a useful clinical measurement for mycosis fungoides. The SWAT score captures overall physician impressions of disease status on a continuous dimensionless numerical scale, therefore providing a defined, objective, and sensitive quantitative measure. This tool is suitable for individual patient assessment, clinical trials, and outcome comparisons.

From the Departments of Dermatology, University Hospitals of Cleveland, Case Western Reserve University (Drs Stevens, Ke, Parry, Mark, and Cooper), and Veterans Affairs Medical Center (Drs Stevens and Cooper), Cleveland, Ohio; University of Michigan, Ann Arbor (Drs Stevens and Cooper); and Salford Royal Hospitals National Health Service Trust, Manchester, England (Dr Parry).

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