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A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale.

Abstract We wished to validate our recently devised 16-item ENLIST ENL Severity Scale, a clinical tool for measuring the severity of the serious leprosy associated complication of erythema nodosum leprosum (ENL). We also wished to assess the responsiveness of the ENLIST ENL Severity Scale in detecting clinical change in patients with ENL.
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Authors

Mayor MeshTerms

Severity of Illness Index

Keywords
Journal Title plos neglected tropical diseases
Publication Year Start




PMID- 28671966
OWN - NLM
STAT- MEDLINE
DA  - 20170703
DCOM- 20170726
LR  - 20170726
IS  - 1935-2735 (Electronic)
IS  - 1935-2727 (Linking)
VI  - 11
IP  - 7
DP  - 2017 Jul
TI  - A leprosy clinical severity scale for erythema nodosum leprosum: An
      international, multicentre validation study of the ENLIST ENL Severity Scale.
PG  - e0005716
LID - 10.1371/journal.pntd.0005716 [doi]
AB  - OBJECTIVES: We wished to validate our recently devised 16-item ENLIST ENL
      Severity Scale, a clinical tool for measuring the severity of the serious leprosy
      associated complication of erythema nodosum leprosum (ENL). We also wished to
      assess the responsiveness of the ENLIST ENL Severity Scale in detecting clinical 
      change in patients with ENL. METHODS: Participants, recruited from seven centres 
      in six leprosy endemic countries, were assessed using the ENLIST ENL Severity
      Scale by two researchers, one of whom categorised the severity of ENL. At a
      subsequent visit a further assessment using the scale was made and both
      participant and physician rated the change in ENL using the subjective categories
      of "Much better", "somewhat better", "somewhat worse" and "much worse" compared
      with "No change" or "about the same". RESULTS: 447 participants were assessed
      with the ENLIST ENL Severity Scale. The Cronbach alpha of the scale and each item
      was calculated to determine the internal consistency of the scale. The ENLIST ENL
      Severity Scale had good internal consistency and this improved following removal 
      of six items to give a Cronbach's alpha of 0.77. The cut off between mild ENL and
      more severe disease was 9 determined using ROC curves. The minimal important
      difference of the scale was determined to be 5 using both participant and
      physician ratings of change. CONCLUSIONS: The 10-item ENLIST ENL Severity Scale
      is the first valid, reliable and responsive measure of ENL severity and improves 
      our ability to assess and compare patients and their treatments in this severe
      and difficult to manage complication of leprosy. The ENLIST ENL Severity Scale
      will assist physicians in the monitoring and treatment of patients with ENL. The 
      ENLIST ENL Severity Scale is easy to apply and will be useful as an outcome
      measure in treatment studies and enable the standardisation of other clinical and
      laboratory ENL research.
FAU - Walker, Stephen L
AU  - Walker SL
AUID- ORCID: http://orcid.org/0000-0002-2034-8376
AD  - Department of Clinical Research, Faculty of Infectious and Tropical Diseases,
      London School of Hygiene and Tropical Medicine, London, United Kingdom.
FAU - Sales, Anna M
AU  - Sales AM
AD  - Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
FAU - Butlin, C Ruth
AU  - Butlin CR
AD  - Department of Medicine, The Leprosy Mission International, Dhaka, Bangladesh.
FAU - Shah, Mahesh
AU  - Shah M
AD  - Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy
      Mission Nepal, Anandaban Hospital, Kathmandu, Nepal.
FAU - Maghanoy, Armi
AU  - Maghanoy A
AD  - Department of Dermatology, Leonard Wood Memorial Center for TB and Leprosy
      Research, Cebu, Philippines.
FAU - Lambert, Saba M
AU  - Lambert SM
AD  - Department of Clinical Research, Faculty of Infectious and Tropical Diseases,
      London School of Hygiene and Tropical Medicine, London, United Kingdom.
AD  - Department of Family Medicine, Suisse Clinic, Addis Ababa, Ethiopia.
FAU - Darlong, Joydeepa
AU  - Darlong J
AD  - Department of Medicine, The Leprosy Mission Hospital, Purulia, India.
FAU - Rozario, Benjamin Jewel
AU  - Rozario BJ
AD  - Department of Medicine, The Leprosy Mission International, Dhaka, Bangladesh.
FAU - Pai, Vivek V
AU  - Pai VV
AD  - Bombay Leprosy Project, Mumbai, India.
FAU - Balagon, Marivic
AU  - Balagon M
AD  - Department of Dermatology, Leonard Wood Memorial Center for TB and Leprosy
      Research, Cebu, Philippines.
FAU - Doni, Shimelis N
AU  - Doni SN
AD  - Department of Dermatology, ALERT Center, Addis Ababa, Ethiopia.
FAU - Hagge, Deanna A
AU  - Hagge DA
AD  - Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy
      Mission Nepal, Anandaban Hospital, Kathmandu, Nepal.
FAU - Nery, Jose A C
AU  - Nery JAC
AD  - Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
FAU - Neupane, Kapil D
AU  - Neupane KD
AD  - Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy
      Mission Nepal, Anandaban Hospital, Kathmandu, Nepal.
FAU - Baral, Suwash
AU  - Baral S
AD  - Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy
      Mission Nepal, Anandaban Hospital, Kathmandu, Nepal.
FAU - Sangma, Biliom A
AU  - Sangma BA
AD  - Department of Medicine, The Leprosy Mission International, Dhaka, Bangladesh.
FAU - Alembo, Digafe T
AU  - Alembo DT
AD  - Department of Dermatology, ALERT Center, Addis Ababa, Ethiopia.
FAU - Yetaye, Abeba M
AU  - Yetaye AM
AD  - Department of Dermatology, ALERT Center, Addis Ababa, Ethiopia.
FAU - Hassan, Belaynesh A
AU  - Hassan BA
AD  - Department of Dermatology, ALERT Center, Addis Ababa, Ethiopia.
FAU - Shelemo, Mohammed B
AU  - Shelemo MB
AD  - Department of Dermatology, ALERT Center, Addis Ababa, Ethiopia.
FAU - Nicholls, Peter G
AU  - Nicholls PG
AD  - Department of Clinical Research, Faculty of Infectious and Tropical Diseases,
      London School of Hygiene and Tropical Medicine, London, United Kingdom.
FAU - Lockwood, Diana N J
AU  - Lockwood DNJ
AD  - Department of Clinical Research, Faculty of Infectious and Tropical Diseases,
      London School of Hygiene and Tropical Medicine, London, United Kingdom.
CN  - Erythema Nodosum Leprosum International STudy Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Validation Studies
DEP - 20170703
PL  - United States
TA  - PLoS Negl Trop Dis
JT  - PLoS neglected tropical diseases
JID - 101291488
SB  - IM
MH  - Adult
MH  - Erythema Nodosum/*pathology
MH  - Female
MH  - Humans
MH  - Leprosy, Lepromatous/*pathology
MH  - Male
MH  - Middle Aged
MH  - *Severity of Illness Index
MH  - Young Adult
EDAT- 2017/07/04 06:00
MHDA- 2017/07/27 06:00
CRDT- 2017/07/04 06:00
PHST- 2017/03/08 [received]
PHST- 2017/06/16 [accepted]
PHST- 2017/07/14 [revised]
AID - 10.1371/journal.pntd.0005716 [doi]
AID - PNTD-D-17-00332 [pii]
PST - epublish
SO  - PLoS Negl Trop Dis. 2017 Jul 3;11(7):e0005716. doi: 10.1371/journal.pntd.0005716.
      eCollection 2017 Jul.