student research day - Case Western Reserve University School of ...

Katrina Gipson
PHYSICAN-PATIENT CONCORDANCE REGARDING RELEVANCE OF POSITIVE PATCH TESTS
Katrina Gipson, Sean Carlson, DO, Susan Nedorost, MD
Department of Dermatology
University Hospitals/Case Medical Center, Cleveland, OH
Background: The efficacy of patch testing may be enhanced by data allowing the physician to estimate
the likelihood that results of a patch test reading are relevant to patients’ dermatitis.
Objective: The goal of this study is to compare the rates of agreement between the physician’s
assessment of relevance at time of final reading and patient’s report of whether avoidance of an allergen
was needed to remain free of dermatitis.
Methods: We mailed 407 IRB-approved questionnaires to patients and 118 surveys were returned. We
analyzed results for 91 patients reporting greater than 80% improvement of their dermatitis. Crossreacting
allergens tested on the same patient were combined for analysis. Cohen’s kappa was used to
assess inter-rater reliability.
Results: Cohen’s kappa: all allergens: -0.067 (95% CI -0.24-0.10); nickelsulfate hexahydrate: -0.11 (95%
CI -0.52-0.30); neomycin sulfate: -0.18 (95% CI -0.94-0.58); fragrance: -0.046 (95% CI -.044-0.36);
formaldehyde and formaldehyde releasing preservatives: 0 (95% CI -1.3-1.3). For most allergens,
agreement between raters was less than chance agreement excluding formaldehyde, where raters’
agreement equals that of chance agreement. Sample size limits statistical significance.
Conclusion: Relevance may vary between allergens or with anatomic affected areas. Physician
assessment of relevance at time of final reading is a poor measure of which allergens are responsible
for the allergic contact dermatitis. This may have implications for when best to determine the relevance
of certain allergens.
Supported by the Crile Fellowship
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