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Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)

Burden-Teh, Esther; Murphy, Ruth; Gran, Sonia; Nijsten, Tamar; Hughes, Carolyn; Abdul-Wahab, Alya; Bewley, Anthony; Burrows, Nigel; Darne, Sharmela; Gach, Joanna E; Katugampola, Ru; Jury, Catherine S.; Kuet, Kar-Hung; Llewellyn, Joanne; McPherson, Tess; Ravenscroft, Jane C.; Taibjee, Saleem; Wilkinson, Cairine; Thomas, Kim S.

Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study) Thumbnail


Authors

Ruth Murphy

SONIA GRAN SONIA.GRAN@NOTTINGHAM.AC.UK
Associate Professor

Tamar Nijsten

Carolyn Hughes

Alya Abdul-Wahab

Anthony Bewley

Nigel Burrows

Sharmela Darne

Joanna E Gach

Ru Katugampola

Catherine S. Jury

Kar-Hung Kuet

Joanne Llewellyn

Tess McPherson

Jane C. Ravenscroft

Saleem Taibjee

Cairine Wilkinson



Abstract

Background
In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared to adults.

Objectives
To test the diagnostic accuracy of previously agreed consensus criteria and develop a shortlist of best predictive diagnostic criteria for childhood psoriasis.

Methods
A case-control diagnostic accuracy study in 12 UK dermatology departments (2017-2019) assessed 18 clinical criteria using blinded trained investigators. Children (less than 18 years) with dermatologist diagnosed psoriasis (cases n=160) or a different scaly inflammatory rash (controls n=170) were recruited. The best predictive criteria were identified using backward logistic regression and internal validation was conducted using bootstrapping.

Results
The sensitivity of the consensus agreed criteria and consensus scoring algorithm was 84.4%, specificity was 65.1% and area under the curve (AUC) 0.75. Seven diagnostic criteria which performed best were: i) scale and erythema in the scalp involving the hairline; ii) scaly erythema inside the external auditory meatus; iii) persistent well-demarcated erythematous rash anywhere on the body; iv) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees; v) persistent erythema in the umbilicus; vi) well demarcated erythematous rash in the napkin area involving the crural folds; vii) family history of psoriasis. Sensitivity of the best predictive model was 76.8%, specificity 72.7% and AUC 0.84. The c-statistic optimism adjusted shrinkage factor was 0.012.

Conclusions
This study provides examination and history-based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary care patients. External validation is now needed.

Citation

Burden-Teh, E., Murphy, R., Gran, S., Nijsten, T., Hughes, C., Abdul-Wahab, A., …Thomas, K. S. (2022). Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study). British Journal of Dermatology, 186(2), 341-351. https://doi.org/10.1111/bjd.20689

Journal Article Type Article
Acceptance Date Aug 5, 2021
Online Publication Date Nov 24, 2021
Publication Date 2022-02
Deposit Date Aug 12, 2021
Publicly Available Date Mar 29, 2024
Journal British Journal of Dermatology
Print ISSN 0007-0963
Electronic ISSN 1365-2133
Peer Reviewed Peer Reviewed
Volume 186
Issue 2
Pages 341-351
DOI https://doi.org/10.1111/bjd.20689
Public URL https://nottingham-repository.worktribe.com/output/5957191
Publisher URL https://onlinelibrary.wiley.com/doi/10.1111/bjd.20689

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