The Oxford Finger Nail Appearance Score - a new scoring system for fingernail deformity following paediatric finger tip trauma

On behalf of the NINJA Collaborative; NINJA Collaborative

doi:10.1016/j.bjps.2020.08.002

The Oxford Finger Nail Appearance Score - a new scoring system for fingernail deformity following paediatric finger tip trauma

On behalf of the NINJA Collaborative, NINJA Collaborative

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Fingernail deformity is common, yet current methods used to define cosmetic appearance following trauma are mainly descriptive. In order to quantify the cosmetic appearance of the fingernail, we developed the Oxford Fingernail Appearance Score using a three stage iterative process. The score has five cosmetic components marked as binary outcomes composed of nail shape, nail adherence, eponychial appearance, nail surface appearance and presence of a split. In the first stage, two assessors independently assessed 25 photographs of fingernails taken at a minimum of four months following paediatric nail bed repair and compared them to the corresponding contralateral uninjured finger. Following refinement in the score, ten different assessors scored a further 62 photographs of fingernails taken after paediatric nail bed repair. Assessors completed each of the five components, and the overall component score was calculated by statisticians post-hoc, taking the ideal appearance of each component as 1 (“identical to opposite” for nail shape, eponychium and surface, “complete” for adherence, “absent” for split) and all the non-ideal appearances as 0. Assessors effectively scored the photographs’ integer values between 0 (least optimal appearance) and 5 (most optimal appearance). Refinements in the scoring system resulted in an improvement in a weighted kappa statistic of 0.36 (95% CI:0.09,0.68) in the initial score to 0.52 (95% CI: 0.42, 0.61). The Oxford Fingernail Appearance Score is a user-friendly and reliable scoring system which has application in a clinical trial setting.

Original language	English
Pages (from-to)	94-100
Number of pages	7
Journal	Journal of Plastic, Reconstructive and Aesthetic Surgery
Volume	74
Issue number	1
DOIs	https://doi.org/10.1016/j.bjps.2020.08.002
Publication status	Published - Jan 2021

Bibliographical note

Funding Information:
AJ, MDG, CC, AS, JC, DB and AVHG obtained grant funding for this project. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1215-20041) and was supported by the NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2020

Keywords

Appearance
Fingernail
Oxford score
Trauma

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10.1016/j.bjps.2020.08.002

Cite this

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title = "The Oxford Finger Nail Appearance Score - a new scoring system for fingernail deformity following paediatric finger tip trauma",

abstract = "Fingernail deformity is common, yet current methods used to define cosmetic appearance following trauma are mainly descriptive. In order to quantify the cosmetic appearance of the fingernail, we developed the Oxford Fingernail Appearance Score using a three stage iterative process. The score has five cosmetic components marked as binary outcomes composed of nail shape, nail adherence, eponychial appearance, nail surface appearance and presence of a split. In the first stage, two assessors independently assessed 25 photographs of fingernails taken at a minimum of four months following paediatric nail bed repair and compared them to the corresponding contralateral uninjured finger. Following refinement in the score, ten different assessors scored a further 62 photographs of fingernails taken after paediatric nail bed repair. Assessors completed each of the five components, and the overall component score was calculated by statisticians post-hoc, taking the ideal appearance of each component as 1 (“identical to opposite” for nail shape, eponychium and surface, “complete” for adherence, “absent” for split) and all the non-ideal appearances as 0. Assessors effectively scored the photographs{\textquoteright} integer values between 0 (least optimal appearance) and 5 (most optimal appearance). Refinements in the scoring system resulted in an improvement in a weighted kappa statistic of 0.36 (95% CI:0.09,0.68) in the initial score to 0.52 (95% CI: 0.42, 0.61). The Oxford Fingernail Appearance Score is a user-friendly and reliable scoring system which has application in a clinical trial setting.",

keywords = "Appearance, Fingernail, Oxford score, Trauma",

author = "{On behalf of the NINJA Collaborative} and {NINJA Collaborative} and Abhilash Jain and Jamie Stokes and Gardiner, {Matthew D.} and Cook, {Jonathan A.} and Amy Jones and Cushla Cooper and Beverly Shirkey and Adam Sierakowski and David Beard and Greig, {Aina V.H.} and Sophie Dupr{\'e} and Adami, {Raina Zarb} and Benjamin Baker and Malik Fleet and Debbie Miles and Rebecca Nicholas and Alexi Nicola and Agata Plonczak and Aseel Sleiwah and Georgina Williams",

note = "Funding Information: AJ, MDG, CC, AS, JC, DB and AVHG obtained grant funding for this project. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1215-20041) and was supported by the NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2020",

year = "2021",

month = jan,

doi = "10.1016/j.bjps.2020.08.002",

language = "English",

volume = "74",

pages = "94--100",

journal = "Journal of Plastic, Reconstructive and Aesthetic Surgery",

issn = "1748-6815",

publisher = "Churchill Livingstone",

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}

The Oxford Finger Nail Appearance Score - a new scoring system for fingernail deformity following paediatric finger tip trauma. / On behalf of the NINJA Collaborative; NINJA Collaborative.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 74, No. 1, 01.2021, p. 94-100.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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AU - On behalf of the NINJA Collaborative

AU - NINJA Collaborative

AU - Jain, Abhilash

AU - Stokes, Jamie

AU - Gardiner, Matthew D.

AU - Cook, Jonathan A.

AU - Jones, Amy

AU - Cooper, Cushla

AU - Shirkey, Beverly

AU - Sierakowski, Adam

AU - Beard, David

AU - Greig, Aina V.H.

AU - Dupré, Sophie

AU - Adami, Raina Zarb

AU - Baker, Benjamin

AU - Fleet, Malik

AU - Miles, Debbie

AU - Nicholas, Rebecca

AU - Nicola, Alexi

AU - Plonczak, Agata

AU - Sleiwah, Aseel

AU - Williams, Georgina

N1 - Funding Information: AJ, MDG, CC, AS, JC, DB and AVHG obtained grant funding for this project. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1215-20041) and was supported by the NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2020

PY - 2021/1

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N2 - Fingernail deformity is common, yet current methods used to define cosmetic appearance following trauma are mainly descriptive. In order to quantify the cosmetic appearance of the fingernail, we developed the Oxford Fingernail Appearance Score using a three stage iterative process. The score has five cosmetic components marked as binary outcomes composed of nail shape, nail adherence, eponychial appearance, nail surface appearance and presence of a split. In the first stage, two assessors independently assessed 25 photographs of fingernails taken at a minimum of four months following paediatric nail bed repair and compared them to the corresponding contralateral uninjured finger. Following refinement in the score, ten different assessors scored a further 62 photographs of fingernails taken after paediatric nail bed repair. Assessors completed each of the five components, and the overall component score was calculated by statisticians post-hoc, taking the ideal appearance of each component as 1 (“identical to opposite” for nail shape, eponychium and surface, “complete” for adherence, “absent” for split) and all the non-ideal appearances as 0. Assessors effectively scored the photographs’ integer values between 0 (least optimal appearance) and 5 (most optimal appearance). Refinements in the scoring system resulted in an improvement in a weighted kappa statistic of 0.36 (95% CI:0.09,0.68) in the initial score to 0.52 (95% CI: 0.42, 0.61). The Oxford Fingernail Appearance Score is a user-friendly and reliable scoring system which has application in a clinical trial setting.

AB - Fingernail deformity is common, yet current methods used to define cosmetic appearance following trauma are mainly descriptive. In order to quantify the cosmetic appearance of the fingernail, we developed the Oxford Fingernail Appearance Score using a three stage iterative process. The score has five cosmetic components marked as binary outcomes composed of nail shape, nail adherence, eponychial appearance, nail surface appearance and presence of a split. In the first stage, two assessors independently assessed 25 photographs of fingernails taken at a minimum of four months following paediatric nail bed repair and compared them to the corresponding contralateral uninjured finger. Following refinement in the score, ten different assessors scored a further 62 photographs of fingernails taken after paediatric nail bed repair. Assessors completed each of the five components, and the overall component score was calculated by statisticians post-hoc, taking the ideal appearance of each component as 1 (“identical to opposite” for nail shape, eponychium and surface, “complete” for adherence, “absent” for split) and all the non-ideal appearances as 0. Assessors effectively scored the photographs’ integer values between 0 (least optimal appearance) and 5 (most optimal appearance). Refinements in the scoring system resulted in an improvement in a weighted kappa statistic of 0.36 (95% CI:0.09,0.68) in the initial score to 0.52 (95% CI: 0.42, 0.61). The Oxford Fingernail Appearance Score is a user-friendly and reliable scoring system which has application in a clinical trial setting.

KW - Appearance

KW - Fingernail

KW - Oxford score

KW - Trauma

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U2 - 10.1016/j.bjps.2020.08.002

DO - 10.1016/j.bjps.2020.08.002

M3 - Article (Academic Journal)

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VL - 74

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JO - Journal of Plastic, Reconstructive and Aesthetic Surgery

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SN - 1748-6815

IS - 1

ER -

The Oxford Finger Nail Appearance Score - a new scoring system for fingernail deformity following paediatric finger tip trauma

Abstract

Bibliographical note

Keywords

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