REMOTE atopic dermatitis diagnosis using parent or caregiver reports showed promise for identifying the condition in children younger than two years, with proxy reports of a clinician diagnosis demonstrating stronger diagnostic performance than a Childhood Eczema Questionnaire.
Researchers conducted a post-hoc analysis of data from the CASCADE prevention trial, assessing two approaches to remote identification of atopic dermatitis. The analysis included 933 children with available data at 12 and 24 months of age.
The researchers compared responses from the Childhood Eczema Questionnaire and a Proxy Report of a Clinician Atopic Dermatitis Diagnosis against a clinician’s chart diagnosis, which served as the reference standard. The reference diagnoses were made by primary care clinicians or paediatricians who had received additional training in diagnosing atopic dermatitis.
Atopic dermatitis was documented in 26.2% of the cohort at 24 months.
The Proxy Report of a Clinician Atopic Dermatitis Diagnosis demonstrated sensitivity and specificity of 65.8% and 91.3%, respectively, at 12 months. At 24 months, these increased to 71.6% and 93.2%.
Its positive predictive value and negative predictive value were 72.5% and 88.5% at 12 months, rising to 88.3% and 82.2% at 24 months.
The Childhood Eczema Questionnaire showed lower sensitivity, although specificity remained above 90% at both assessment points. At 12 months, sensitivity and specificity were 46.3% and 91.5%, respectively, compared with 50.9% and 93.2% at 24 months.
The Childhood Eczema Questionnaire had positive and negative predictive values of 64.5% and 83.5% at 12 months, and 84.1% and 72.8% at 24 months.
The most common reasons for false-negative questionnaire results were the absence of proxy-observed or reported itch or rash.
The researchers concluded that the Proxy Report of a Clinician Atopic Dermatitis Diagnosis performed well across sensitivity, specificity, positive predictive value, and negative predictive value, followed by the Childhood Eczema Questionnaire.
The findings provide evidence supporting proxy clinician diagnosis as an approach for remotely identifying atopic dermatitis cases in research involving children younger than two years who have access to healthcare. The study also highlights the potential value of remote diagnostic methods where direct clinical assessment is not feasible.
Reference
Fang MM et al. Remote identification of new onset pediatric atopic dermatitis – a comparison of diagnostic methods from a post-hoc analysis of the CASCADE prevention trial. Br J Dermatol. 2026;DOI:10.1093/bjd/ljag347.
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