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The PEN (POEM EASI NICE) study: The routine use of Patient Orientated Eczema Measure, Eczema Area Severity Index and NICE assessments of eczema severity to guide the treatment of children with eczema


Bristol Medical School

Applications accepted all year round Self-Funded PhD Students Only

About the Project

Rationale
Eczema (otherwise known as atopic eczema/dermatitis) is common in childhood and has a significant impact on many families. In the UK, the majority are treated exclusively in primary care by their GP with emollients and topical corticosteroids (TCS).

NICE guidelines advocate, based on a global clinical assessment of eczema severity, matching the potency of TCS to the severity of the child’s disease. However, it is without an evidence base: the NICE categories and descriptions were based on guideline group consensus, and are not underpinned by any research into their validity or utility.

POEM and EASI are the recommended patient-reported and objective clinician-reported scales respectively. Both have the advantage of being freely available, with published cut-offs for severity to aid clinical interpretability. There is little/no work either validating the NICE assessment or comparing POEM, EASI or NICE severity categories with potency of TCS treatment.

Aims & Objectives
1. To systematically review studies evaluating the use of disease severity and quality of life instruments for people with eczema in routine clinical settings
2. To compare POEM, EASI and NICE assessments of eczema severity with topical corticosteroid (TCS) treatment recommendations made by GPs, dermatology nurses and dermatologists
3. To determine the feasibility and explore the effectiveness of using POEM, EASI and/or NICE assessments of eczema severity to guide treatment

Methods
1. Systematic review of the literature for studies evaluating the use of measures of disease severity in eczema in routine clinical settings.
2. Comparison of POEM, EASI and NICE assessments of eczema severity with treatment recommendations. Using exemplar cases, healthcare professionals (HCPs), will be asked to assess the children with different severities of eczema and make TCS treatment recommendations. Assessments and recommendations will be compared by healthcare profession.
3. Evaluation of the feasibility of the routine use of eczema severity measures. HCPs will apply eczema severity measure(s) and recommendations in routine care. Mixed methods evaluation: exploratory analyses will be undertaken comparing children who did/did not have their eczema severity assessed; their mean change in POEM scores, use of eczema treatments; in-depth interviews with a sample of participating HCPs and parents/children to explore their experiences and views of taking part in the study.

References

NICE guideline CG57. Atopic Eczema in Children. London; 2007.

Charman CR, Venn AJ, Williams HC. The Patient-Oriented Eczema Measure. Archives of Dermatology 2004; 140: 1513-9

Hanifin JM, Thurston M, Omoto M, et al. The eczema area and severity index (EASI). Experimental Dermatology 2001; 10: 11-8

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