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

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
The aims of the project are:
• To systematically review studies evaluating the use of disease severity and quality of life instruments for people with eczema in routine clinical settings
• To compare POEM, EASI and NICE assessments of eczema severity with topical corticosteroid (TCS) treatment recommendations made by GPs, dermatology nurses and dermatologists
• To determine the feasibility and explore the effectiveness of using POEM, EASI and/or NICE assessments of eczema severity to guide

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.