Developing and validating the Cutaneous WARTS (CWARTS) diagnostic tool: a novel clinical assessment and classification system for cutaneous warts. (1st February 2018)

• Record Type: Journal Article
• Authors: Hogendoorn, G.K.; Bruggink, S.C.; Hermans, K.E.; Kouwenhoven, S.T.P.; Quint, K.D.; Wolterbeek, R.; Eekhof, J.A.H.; de Koning, M.N.C.; Rissmann, R.; Burggraaf, J.; Bouwes Bavinck, J.N.
• Is Part Of: British journal of dermatology. Volume 178:Number 2(2018)
• Page Start: e156
• Page End: e156
• Publication Date: 2018-02-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.16281
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Not all skin (cutaneous) warts look the same. This study from the Netherlands aimed to develop and test an accurate diagnostic tool to help clinicians diagnose warts. The authors defined nine characteristics of appearance using literature and interviews with experts. This led to the development of the Cutaneous WART Diagnostic tool (the CWARTS diagnostic tool). The study consisted of two parts. In the first part, part A, 28 researchers ('observers') assessed photographs of 10 warts and the team investigated how well the researchers agreed with each other. In the second part, part B, this was repeated with 6 researchers and 299 warts and the team tested how consistent these 6 observers were between a first and second assessment after a period of 1 week or longer. For the nine characteristics of warts a widely used reliability index, named the intraclass correlation coefficient (ICC), was calculated. In other words, if the ICC is higher it means there is more agreement between observers or observers are more consistent. Presence of black dots had an excellent agreement between observers (0.85), followed by arrangement of the warts (0.65), presence of redness at the border of a wart (0.64) and contrast of the border (0.60). In part B of the study these results were similar. For consistency between a first and second assessment, presence of black dots again had the highest consistency followed by presence of border redness (0.64) and the colour of the wart (0.55). With this study the authors demonstrated that the appearance of cutaneous warts can be reliably assessed with the CWARTS diagnostic tool.