An Oral Disease Severity Score validated for use in oral pemphigus vulgaris

M. Ormond, H. McParland, A.N.A. Donaldson, M. Andiappan, R.J. Cook, M. Escudier, E. Hullah, J. Higham, R. McMillan, J. Taylor, P.J. Shirlaw, S.J. Challacombe, J.F. Setterfield

The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in pemphigus vulgaris (PV). A secondary aim was to compare the inter - intra- observer variability and ease of use with the Physician's Global Assessment (PGA) and the oral scoring methods used in Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI). 15 patients with mild to moderately severe oral PV were scored for disease severity by 10 oral medicine clinicians using the ODSS, PGA and the oral sections of ABSIS and PDAI. Two clinicians re-scored all patients after a minimum two-hour interval. Inter-observer reliability was assessed using an intra-class correlation coefficient (ICC). For the ODSS total score the ICC was 0.83, PDAI (oral total activity) 0.79 ABSIS (oral total) 0.71 and PGA was 0.7. Intra-observer agreement between initial scoring and re-scoring of the same subject by two clinicians demonstrated an ICC for each of 0.97 and 0.96 for ODSS total score; 0.99 and 0.82 for the PDAI oral activity; 0.86 and 0.45 for the ABSIS total and 0.99 and 0.64 for the PGA. Convergent validity was good with a correlation coefficient of greater than 0.5 (p<0.0001). The mean time (SD) (seconds) taken to complete each scoring method was: ODSS 76±37; PDAI 117±16; ABSIS 75±19. This study has validated the ODSS for the assessment of oral PV. It has shown superior inter- and intra-observer reliability to PDAI, ABSIS and PGA and is quick to perform. This article is protected by copyright. All rights reserved.