Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis

Murray Baron, Lorinda Chung, Geneviève Gyger, Laura Hummers, Dinesh Khanna, Maureen D. Mayes, Janet E. Pope, Ami Shah, Virginia D. Steen, Russell Steele, Solène Tatibouet, Ariane Herrick, Ulf Müller-Ladner, Marie Hudson

Research output: Contribution to journalArticle

Abstract

The objectives of this study were to develop a standard classification of digital ulcers (DUs) in systemic sclerosis (SSc) for use in observational or therapeutic studies and to assess the reliability of these definitions as well as of the measurement of ulcer area. Ten North American rheumatologists with expertise in SSc reviewed multiple photos of DUs, examined four SSc subjects with DUs, and came to a consensus on the definitions for digital, active, healed, and indeterminate ulcers. These ten raters then examined the right hand of ten SSc subjects twice and the left hand once to classify ulcers and to measure ulcer area. Weighted and Fleiss kappa were used to calculate intra- and interrater agreement on classification of ulcers, and intraclass correlation coefficient (ICC) was used to assess agreement on ulcer area. Because the traditional ICC calculations relied on a small number of ulcers, ICCs were recalculated using the results of linear mixed models to evaluate the variance components of observations on all the data. Intrarater kappa for classifying DU as not an ulcer/healed ulcer versus active/indeterminate ulcer was substantial (0.76), and interrater kappa was moderate (0.53). The ICC for ulcer area using the linear mixed models was moderate both for intrarater (0.57) and interrater (0.48) measurements. A consensus for the classification of DUs in SSc was developed, and after a training session, rheumatologists with expertise in SSc are able to reliably classify DUs and to measure ulcer area.

Original languageEnglish (US)
Pages (from-to)207-214
Number of pages8
JournalClinical Rheumatology
Volume33
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Systemic Scleroderma
Ulcer
Linear Models
Hand

Keywords

  • Digital ulcers
  • Ischemia
  • Psychometrics
  • Reliability
  • Scleroderma
  • Systemic sclerosis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis. / Baron, Murray; Chung, Lorinda; Gyger, Geneviève; Hummers, Laura; Khanna, Dinesh; Mayes, Maureen D.; Pope, Janet E.; Shah, Ami; Steen, Virginia D.; Steele, Russell; Tatibouet, Solène; Herrick, Ariane; Müller-Ladner, Ulf; Hudson, Marie.

In: Clinical Rheumatology, Vol. 33, No. 2, 02.2014, p. 207-214.

Research output: Contribution to journalArticle

Baron, M, Chung, L, Gyger, G, Hummers, L, Khanna, D, Mayes, MD, Pope, JE, Shah, A, Steen, VD, Steele, R, Tatibouet, S, Herrick, A, Müller-Ladner, U & Hudson, M 2014, 'Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis', Clinical Rheumatology, vol. 33, no. 2, pp. 207-214. https://doi.org/10.1007/s10067-013-2460-7
Baron, Murray ; Chung, Lorinda ; Gyger, Geneviève ; Hummers, Laura ; Khanna, Dinesh ; Mayes, Maureen D. ; Pope, Janet E. ; Shah, Ami ; Steen, Virginia D. ; Steele, Russell ; Tatibouet, Solène ; Herrick, Ariane ; Müller-Ladner, Ulf ; Hudson, Marie. / Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis. In: Clinical Rheumatology. 2014 ; Vol. 33, No. 2. pp. 207-214.
@article{a255229fd9cb48729b23148c94bc487b,
title = "Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis",
abstract = "The objectives of this study were to develop a standard classification of digital ulcers (DUs) in systemic sclerosis (SSc) for use in observational or therapeutic studies and to assess the reliability of these definitions as well as of the measurement of ulcer area. Ten North American rheumatologists with expertise in SSc reviewed multiple photos of DUs, examined four SSc subjects with DUs, and came to a consensus on the definitions for digital, active, healed, and indeterminate ulcers. These ten raters then examined the right hand of ten SSc subjects twice and the left hand once to classify ulcers and to measure ulcer area. Weighted and Fleiss kappa were used to calculate intra- and interrater agreement on classification of ulcers, and intraclass correlation coefficient (ICC) was used to assess agreement on ulcer area. Because the traditional ICC calculations relied on a small number of ulcers, ICCs were recalculated using the results of linear mixed models to evaluate the variance components of observations on all the data. Intrarater kappa for classifying DU as not an ulcer/healed ulcer versus active/indeterminate ulcer was substantial (0.76), and interrater kappa was moderate (0.53). The ICC for ulcer area using the linear mixed models was moderate both for intrarater (0.57) and interrater (0.48) measurements. A consensus for the classification of DUs in SSc was developed, and after a training session, rheumatologists with expertise in SSc are able to reliably classify DUs and to measure ulcer area.",
keywords = "Digital ulcers, Ischemia, Psychometrics, Reliability, Scleroderma, Systemic sclerosis",
author = "Murray Baron and Lorinda Chung and Genevi{\`e}ve Gyger and Laura Hummers and Dinesh Khanna and Mayes, {Maureen D.} and Pope, {Janet E.} and Ami Shah and Steen, {Virginia D.} and Russell Steele and Sol{\`e}ne Tatibouet and Ariane Herrick and Ulf M{\"u}ller-Ladner and Marie Hudson",
year = "2014",
month = "2",
doi = "10.1007/s10067-013-2460-7",
language = "English (US)",
volume = "33",
pages = "207--214",
journal = "Clinical Rheumatology",
issn = "0770-3198",
publisher = "Springer London",
number = "2",

}

TY - JOUR

T1 - Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis

AU - Baron, Murray

AU - Chung, Lorinda

AU - Gyger, Geneviève

AU - Hummers, Laura

AU - Khanna, Dinesh

AU - Mayes, Maureen D.

AU - Pope, Janet E.

AU - Shah, Ami

AU - Steen, Virginia D.

AU - Steele, Russell

AU - Tatibouet, Solène

AU - Herrick, Ariane

AU - Müller-Ladner, Ulf

AU - Hudson, Marie

PY - 2014/2

Y1 - 2014/2

N2 - The objectives of this study were to develop a standard classification of digital ulcers (DUs) in systemic sclerosis (SSc) for use in observational or therapeutic studies and to assess the reliability of these definitions as well as of the measurement of ulcer area. Ten North American rheumatologists with expertise in SSc reviewed multiple photos of DUs, examined four SSc subjects with DUs, and came to a consensus on the definitions for digital, active, healed, and indeterminate ulcers. These ten raters then examined the right hand of ten SSc subjects twice and the left hand once to classify ulcers and to measure ulcer area. Weighted and Fleiss kappa were used to calculate intra- and interrater agreement on classification of ulcers, and intraclass correlation coefficient (ICC) was used to assess agreement on ulcer area. Because the traditional ICC calculations relied on a small number of ulcers, ICCs were recalculated using the results of linear mixed models to evaluate the variance components of observations on all the data. Intrarater kappa for classifying DU as not an ulcer/healed ulcer versus active/indeterminate ulcer was substantial (0.76), and interrater kappa was moderate (0.53). The ICC for ulcer area using the linear mixed models was moderate both for intrarater (0.57) and interrater (0.48) measurements. A consensus for the classification of DUs in SSc was developed, and after a training session, rheumatologists with expertise in SSc are able to reliably classify DUs and to measure ulcer area.

AB - The objectives of this study were to develop a standard classification of digital ulcers (DUs) in systemic sclerosis (SSc) for use in observational or therapeutic studies and to assess the reliability of these definitions as well as of the measurement of ulcer area. Ten North American rheumatologists with expertise in SSc reviewed multiple photos of DUs, examined four SSc subjects with DUs, and came to a consensus on the definitions for digital, active, healed, and indeterminate ulcers. These ten raters then examined the right hand of ten SSc subjects twice and the left hand once to classify ulcers and to measure ulcer area. Weighted and Fleiss kappa were used to calculate intra- and interrater agreement on classification of ulcers, and intraclass correlation coefficient (ICC) was used to assess agreement on ulcer area. Because the traditional ICC calculations relied on a small number of ulcers, ICCs were recalculated using the results of linear mixed models to evaluate the variance components of observations on all the data. Intrarater kappa for classifying DU as not an ulcer/healed ulcer versus active/indeterminate ulcer was substantial (0.76), and interrater kappa was moderate (0.53). The ICC for ulcer area using the linear mixed models was moderate both for intrarater (0.57) and interrater (0.48) measurements. A consensus for the classification of DUs in SSc was developed, and after a training session, rheumatologists with expertise in SSc are able to reliably classify DUs and to measure ulcer area.

KW - Digital ulcers

KW - Ischemia

KW - Psychometrics

KW - Reliability

KW - Scleroderma

KW - Systemic sclerosis

UR - http://www.scopus.com/inward/record.url?scp=84893964907&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893964907&partnerID=8YFLogxK

U2 - 10.1007/s10067-013-2460-7

DO - 10.1007/s10067-013-2460-7

M3 - Article

VL - 33

SP - 207

EP - 214

JO - Clinical Rheumatology

JF - Clinical Rheumatology

SN - 0770-3198

IS - 2

ER -