Читать книгу Graves' Orbitopathy - Группа авторов - Страница 26
How Reproducible Are These Assessments?
ОглавлениеThe assessment of soft-tissue signs will always be somewhat subjective, and the validity of attempting to measure them has therefore been called into question [34]. Nevertheless, they remain of great importance, both for patients who endure the disfigurement, as well as for clinicians who need to clarify the disease phase. It therefore behoves us to attempt to make their assessment as reproducible as possible. Studies show that reproducibility can be improved by the use of a comparative atlas and careful methodology [35, 36]; indeed, observers reached agreement in 86%, and kappa values for soft-tissue signs were moderate or good for most features. Although far from perfect, photographic comparison remains the most reliable method for assessing soft-tissue signs.
Table 1. The clinical activity score (CAS), amended after Mourits et al. [11]
| Painful, oppressive feeling on or behind the globe Pain on attempted up-, side, or downgaze Redness of the eyelids Redness of the conjunctiva Chemosis Inflammatory eyelid swelling Inflammation of caruncle or plica |
| Increase of 2 mm or more in exophthalmos in the last 1 – 3 months Decrease in eye movements of 8° or more in the last 1 – 3 months Decrease in visual acuity in the last 1 – 3 months |
| For initial CAS, only score the first 7 items; the maximum score is 7. One point is given for each feature, ≥3 out of 7 points indicating disease activity. Patients assessed after follow-up (1 – 3 months) can be scored out of 10 by including the last 3 items. One point is given for each feature, ≥4 out of 10 points indicating disease activity. |
