Supplementary Material for: Could Residents Adequately Assess the Severity of Hidradenitis Suppurativa? Interrater and Intrarater Reliability Assessment of Major Scoring Systems

A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.迄今为止，学界已提出多种用于化脓性汗腺炎（hidradenitis suppurativa, HS）的评估工具，但尚无一款符合理想评分系统的标准。由于目前尚无公认的金标准评分系统，评估工具的选择需依据使用目的，甚至取决于临床医师对HS的诊疗经验。本研究旨在评估6种常用于HS严重程度分级的评分系统的评估者内部一致性信度与评估者间信度：Hurley分期系统、改良Hurley分期、化脓性汗腺炎严重程度评分系统（Hidradenitis Suppurativa Severity Score System, IHS4）、化脓性汗腺炎严重程度指数（Hidradenitis Suppurativa Severity Index, HSSI）、Sartorius化脓性汗腺炎评分，以及化脓性汗腺炎医师总体评估量表（Hidradenitis Suppurativa Physician’s Global Assessment Scale, HS-PGA）。评分当日，16名皮肤科住院医师采用全部待评估工具，对9名HS患者进行体格检查与疾病严重程度评估。随后，采用组内相关系数（intraclass correlation coefficient, ICC）计算评估者内部一致性信度，并以变异系数（coefficient of variation, CV）评估评估者间变异度。6种评分系统的组内相关系数均大于0.75，表明所有参评量表均具有较高的评估者内部一致性信度。本研究同时证实，在多数待评估工具中，评估者间存在中等程度的一致性。依据变异系数结果，重现性最佳的方法为Hurley分期、IHS4以及HSSI。通过对比组内相关系数可见，6种待评估评分系统中无任何一款具有显著优势，所有工具均具备较高的可靠性。评估者间信度整体良好，但操作最为简便的量表（包括Hurley分期、IHS4与HSSI）可在研究者间获得最优的重现性结果。