1 / 19

Diagnostic Criteria for Psoriasis in Adults and Children: A Systematic Review

This systematic review examines the evidence from studies aiming to develop or validate diagnostic criteria for psoriasis in adults and children. It discusses the current diagnostic practices and the need for standardized diagnostic criteria.

ruthh
Download Presentation

Diagnostic Criteria for Psoriasis in Adults and Children: A Systematic Review

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A systematic review of diagnostic criteria for psoriasis in adults and children:Evidence from studies with a primary aim to develop or validate diagnostic criteria Burden-Teh E 1, Phillips RC 2, Thomas KS 1, Ratib S 1, Grindlay D 1, Murphy R 3 1 Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK 2 Department of Paediatric Dermatology, Nottingham University Hospitals NHS Trust, Nottingham UK 3 Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK British Journal of Dermatology. DOI: 10.1111/bjd.16104

  2. Introduction What’s already known? • Psoriasis is an immune-mediated chronic inflammatory disease affecting the skin, joints, or both. • Estimated prevalence of 1.0% to 8.5% in adults and up to 2.1% in children.

  3. Introduction (2) • In routine dermatology practice, psoriasis is a clinical diagnosis and the gold (reference) standard is a dermatologist’s diagnosis, supported where needed by histology. • Diagnostic criteria are available for skin conditions such as eczema and Behçets disease. However, for psoriasis diagnostic criteria are currently not widely used.

  4. Introduction (3) • Diagnostic criteria can aid both clinical diagnosis and support standardisation in clinical trials and observational research. • Studies which develop diagnostic criteria should follow the principles of high quality diagnostic accuracy study design and reporting, and then go on to validate the criteria in the study or clinical population they are intended to be used.

  5. Objective • To identify and critically appraise the published studies to date that had a primary research aim to develop or validate diagnostic criteria for psoriasis.

  6. Methods (1) • Protocol was registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015032311 • Reported according to PRISMA checklist.

  7. Methods (2) • Eligibility criteria: Studies with a primary aim to develop or validate diagnostic criteria for psoriasis. Review articles, conference abstracts and studies solely about psoriatic arthritis were excluded. • Primary outcome: Sensitivity and specificity. • Search strategy: MEDLINE and Embase.

  8. Methods (3) • Independent screening, eligibility assessment and data extraction. • Critical appraisal: QUADAS-2 tool (four domains covering patient selection, the diagnostic test, the reference standard, patient flow through the study).

  9. Methods (4) • Planned analysis: Paired forest plots and summary ROC (SROC) curves. Narrative synthesis for secondary outcomes.

  10. Results (1) • 11, 702 studies identified. • 23 studies met the inclusion criteria. • Genetic and molecular (n=8), skin imaging (n=7), histopathology (n=4), computer aided (n=2), questionnaire-based (n=1) and traditional Chinese medicine (n=1).

  11. Results (2) • Case control (n=16), case-series (n=5), cross-sectional (n=1), Delphi consensus (n=1). • Focused on adults, plaque psoriasis and a secondary care population.

  12. Results (3) • 16 diagnostic accuracy studies. • Primary outcome: 13 studies provided sensitivity and specificity data (Figure 2). High sensitivity and specificity was reported in many studies (>90%). • Meta-analysis was not possible due to heterogeneity of the diagnostic criteria.

  13. Results (4) • No studies validated the diagnostic criteria in the setting or population they were intended to be used. 6 studies included validation testing. • No studies developed or validated criteria specifically for a paediatric population. • Many of the included diagnostic accuracy studies had unclear or high risk of bias due to weaknesses in study design and study reporting (Figure 3).

  14. Discussion (1) • No clinical examination-based diagnostic criteria were identified. • Many of the diagnostic criteria identified are test-based. These are likely to be used alongside a clinical assessment as an adjuvant to diagnosis.

  15. Discussion (2) • How these proposed criteria will be used in clinical practice and research needs further exploration. • The diagnostic criteria included in this review require further diagnostic accuracy testing and validation.

  16. Conclusions (1) A gap has been identified in the available literature for clinical examination-based diagnostic criteria, similar to those developed for eczema.

  17. Conclusions (2) Future studies need to: • Consider the study design to minimise bias • Consider the diagnostic challenges of psoriasis affecting particular sites and ages • Describe the proposed criteria’s clinical and research utility • Aim to validate criteria in the population the criteria are intended to be used

  18. The Research Team Dr Esther Burden-Teh Prof. Kim Thomas Dr Douglas Grindlay Dr Sonia Ratib Dr Ruth Murphy

  19. Call for correspondence • Why not join the debate on this article through our correspondence section? • Rapid responses should not exceed 350 words, four references and one figure • Further details can be found here

More Related