Remote identification of new onset pediatric atopic dermatitis - a comparison of diagnostic methods from a post-hoc analysis of the CASCADE prevention trial.

BACKGROUNDFew validated diagnostic criteria for atopic dermatitis (AD) can diagnose AD without a clinician's exam, and even fewer are validated in very young children. Recently, the Community-based Assessment of Skin Care, Allergies, and Eczema (CASCADE) prevention trial remotely captured parent/caregiver responses to the Childhood Eczema Questionnaire and a Proxy Report of a Clinician AD Diagnosis in children ≤2 years of age.

OBJECTIVESTo evaluate the performance of Childhood Eczema Questionnaire and Proxy Report of a Clinician AD Diagnosis for the purpose of remote AD diagnosis.

METHODSData from the CASCADE trial was used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value of Childhood Eczema Questionnaire or Proxy Report of a Clinician AD Diagnosis at 12 and 24 months of age in 933 participants with data available for comparison against the reference standard of a clinician's chart diagnosis of AD, present in 26.2% (244/933 at 24 months) of the cohort. Clinicians who acted as the reference standard were primary care clinicians or pediatricians who received additional training in diagnosing AD.

RESULTSProxy Report of a Clinician AD Diagnosis displayed sensitivity/specificity at 12 months (65.8%/91.3%) and 71.6%/93.2% at 24 months. It also displayed positive and negative predictive values of 72.5%/88.5% at 12 months and 88.3%/82.2% 24 months. The Childhood Eczema Questionnaire showed sensitivity, specificity, positive and negative predictive values of 46.3%/91.5%/64.5%/83.5% at 12 months and 50.9%/93.2%/84.1%/72.8% at 24 months. A lack of proxy-observed or reported itch or rash were the most common reasons for Childhood Eczema Questionnaire false negative cases.

CONCLUSIONSProxy Report of a Clinician AD Diagnosis performed well for sensitivity, specificity, positive and negative predictive values, followed by Childhood Eczema Questionnaire. This U.S. study provides new evidence that supports Proxy Report of a Clinician AD Diagnosis as an adequate approach to identify eczema cases remotely for research in children <2 with access to healthcare.

Abstract from PubMed