Hidradenitis Suppurativa Area and Severity Index Revised (HASI-R): psychometric property assessment*

N. Goldfarb, M. A. Lowes, M. Butt, T. King, A. Alavi, J. S. Kirby

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


BACKGROUND: Validated, reliable, globally accepted outcome measurement instruments for hidradenitis suppurativa (HS) are needed. Current tools to measure the physical signs domain for HS rely on lesion counts, which are time-consuming and unreliable.

OBJECTIVES: To assess the reliability and validity of the Hidradenitis suppurativa Area and Severity Index Revised (HASI-R) tool, a novel method for assessing HS severity, incorporating signs of inflammation and body surface area involved.

METHODS: The measurement properties of the HASI-R tool were evaluated. The tool was created by combining the previously published HASI and Severity and Area Score for Hidradenitis instruments. Twenty raters evaluated 15 patients with HS in a hospital-based ambulatory dermatology clinic. The objectives of the study were to assess inter- and intra-rater reliability of the HASI-R and its components, as well as its construct and known-groups validity. Existing lesion count-based clinician-reported measures of HS and their components were also assessed. Raters were also asked their preferences regarding the various HS severity assessment tools.

RESULTS: The HASI-R had moderate inter-rater reliability [intra-class correlation coefficients (ICC) 0·60]. This was better than all other HS physical sign outcome measures evaluated, which had poor inter-rater reliability (ICC < 0·5). HASI-R had the highest intra-rater reliability (ICC 0·91). The HASI-R had good construct validity and demonstrated known-groups validity. The HASI-R was also the most preferred tool by all raters.

CONCLUSIONS: Results from the clinometric assessment of the HASI-R are encouraging, and support continued evaluation of this clinician-reported outcome measure.

Original languageEnglish (US)
Pages (from-to)905-912
Number of pages8
JournalBritish Journal of Dermatology
Issue number5
StatePublished - May 2021

Bibliographical note

Funding Information:
sources J.S.K. received funding from the Agency for Healthcare Research and Quality for this research (K08HS024585) and the International Dermatology Outcome Measures (IDEOM) organization. Use of REDCap through Penn State is supported by National Institutes of Health/National Clinical Assessment and Treatment Service Grant Number UL1 TR000127 and UL1 TR002014 through The Penn State Clinical & Translational Research Institute, Pennsylvania State University Clinical and Translational Science Awards (CTSA).We thank all the patients who contributed to this study, as well as our clinician raters, which included Haley B. Naik, Gregor B.E. Jemec, John R. Ingram, John W. Frew, Ronda S. Farah, Lori Fiessinger, Megan H. Noe, Robert G. Micheletti, Hadar A. Lev-Tov, Angel S. Byrd, Lauren A. Orenstein, Isabelle Delorme, Nicole Boyer, Iltefat Hamzavi, Stephanie R. Goldberg and Marc Bourcier.

Publisher Copyright:
© 2020 British Association of Dermatologists


  • Hidradenitis Suppurativa/diagnosis
  • Humans
  • Psychometrics
  • Reproducibility of Results
  • Severity of Illness Index

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.


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