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Dr Davis: Recommendations for Assessing Severity in Clinical Practice

The following is a transcript of the video Assessing Severity in Clinical Practice with Dawn M.R. Davis, MD. Dr Davis is a professor of pediatric and adolescent medicine and professor of dermatology as well as division chair of clinical dermatology at Mayo Clinic in Rochester, MN.

Watch the full video by clicking here!

DavisDr Davis: With regards to clinical or scoring assessment of atopic dermatitis and/or quality of life, there are several scales available to dermatologists, primary care providers, allergists, and others. This is not necessarily limited to atopic dermatitis. There are other skin diseases commonly known to dermatologists, such as psoriasis, that also have quality of life or severity indices that can be used.

Whether a provider uses a particular index in his or her clinic is up to the provider and his or her choice. Some find it to be very helpful to monitor a patient over time. Some find it to be of research or statistical data collection use and not necessarily helpful on a day‑to‑day basis with regards to execution and practicality to a particular patient.

Providers should be mindful and aware that while various quality‑of‑life assessments and scoring systems are available to providers, certain insurance companies or healthcare consortiums will require a quality‑of‑life assessment, pain scale, or other quality‑of‑life or severity index in order to cover the patient's visit to the provider and/or treatments.

What we like to do in our practice is use a 1 to 10 scale. I will say, "With 1 being almost nothing and 10 being the most absolute severe you can imagine, where would you put your sleep hygiene, sleep regimen, itch, discomfort, pain, concern, bullying or embarrassment?"

For children who are younger and can't necessarily articulate, you can use a picture diagram of a happy face escalating all the way to an angry or sad face and ask them to point to the face.

Then, I'd like to also list their activities of daily living and top hobbies. When I see them and follow up, I ask them, "Were you able to continue swimming? Have you had to adapt your swimming regimen? Have you had to give up swimming? How are you accommodating swimming into your life with eczema? Just because you have eczema, our goal is to keep you swimming."

These are how I mark in my clinic with my patients a relative gradation of not only severity and quality of life but also their response to treatment so that I know if we need to ratchet up the care treatment or if we can keep it as is.

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