Relation between patients' and physicians' severity assessment of occupational hand eczema

Background Severity assessment of occupational hand eczema (OHE) is important not only in clinical settings but also in research. Questionnaires with self-rated assessment of severity may be an attractive tool for assessing severity because of their cost efficiency in comparison with expensive clinical examinations. Objectives To evaluate the relation between self-rated severity and severity assessment based on standardized medical certificates issued by dermatologists in a population of patients with OHE. Methods Between October 2001 and November 2002 (58 weeks) we identified all new cases of recognized OHE from the Danish National Board of Industrial Injuries (DNBII) registry. Each patient was examined by a dermatologist, who issued a standardized medical certificate. The severity assessment in the DNBII registry was based on this medical certificate, which comprised information on morphology and extent of eczema, and frequency of eruptions. All participants received a self-administered questionnaire and were asked to classify severity of their OHE on a visual analogue scale from 0 to 10. The relation between DNBII-assessed and self-rated severity was illustrated by a receiver operating characteristic analysis. Results Of 758 patients included in the study, 621 returned the questionnaire and 602 (79%) provided information on self-rated severity. The proportion of severe cases was significantly higher among patients' assessments compared with the rating by the DNBII. Almost 18% were categorized as severe cases by the DNBII while 40% of patients had assessed themselves as having severe eczema. The optimal cut-off point had a sensitivity and specificity of self-rated severity according to the DNBII assessment of 65% and 66%, respectively. The positive predictive value was 29% and the negative predictive value was 90%. Conclusions The low positive predictive value suggests major differences in the criteria for self-rated severity vs. DNBII-rated severity. We recommend researchers to include ratings from both patients and physicians in future investigations of severity. The methods may address different aspects of OHE.