Performance characteristics of the venous clinical severity score

Objective: To facilitate study of the natural history and management of venous disease, a 10-component venous; clinical severity (VCS) score has been proposed as an objective measure of disease severity. The purpose of this study was to evaluate the validity and reliability of this instrument. Methods: VCS component scores (0 to 3) for pain, varicose veins, edema, pigmentation, inflammation, induration, stocking use, and ulcer size, duration, and number were measured in consecutive patients with chronic venous disease. Differences between observers (n = 3) and on serial evaluation by the same observer were determined. Results. One hundred twenty-eight limbs in 64 patients were evaluated. Mean VCS score increased from CEAP class 0 (1.7 +/- 1.8) to class 6 (14.7 +/- 3.0; R =.84; P <.0001). Scores in 68 limbs evaluated twice by the same observer differed by a mean of only 0.8 (P =.15), with a reliability coefficient of 0.6. Mean scores of 8.0 (+/- 5.1), 7.2 (+/- 5.1), and 8.0 (+/- 5.4) were obtained in 63 limbs evaluated by all three investigators (P =.02). Only the component scores for pain, inflammation, and pigmentation showed significant (P <.05) interobserver variability. Interobserver agreement on the absence of disease or presence of severe disease as defined by scores of 3 or less or 8 or more was good (kappa = 0.59 and 0.65, respectively). Conclusion: The VCS score is a critically needed tool for evaluating changes in venous disease over time. The score is reliable and shows good correlation with CEAP clinical classification.