Interobserver variability of modified Ferriman-Gallwey hirsutism score in a Turkish population

The aim of the study was to evaluate the interobserver variability of modified Ferriman-Gallwey (mFG) hirsutism scores on each body area in a Turkish population. A cross-sectional study of simultaneous mFG scoring design was used. Observers did not make any interview with the subjects and were masked to the previous score results. Analyses included percentage of agreement, kappa coefficients, the Bland and Altman plot, confidence intervals, minimum and maximum kappa coefficients. The study was performed at a teaching and research hospital. Hundred and twenty-one Turkish women without any complaints of excessive body hair were studied. Interventions included two special trained physicians, simultaneous and independent mFG scoring. The main outcome measures were mFG scores in each body area. Agreement analysis demonstrated that the scores of the two physicians were quite concordant. The mean kappa value for nine body area was 0.744 and the highest kappa values from the upper back and the lowest kappa values from the upper lip revealed D-o = 0.847, D-o = 0.585, respectively. The highest (upper lip) and the lowest (arm) mean range scores for the two researchers among the 9 areas were 1.46-1.55 and 0.17-0.12, respectively. Only 68.6 and 67.8% of the mFG scores observed by each of the two observers were equal or below 8. The mFG scoring system was found to be clinically useful. The upper lip was observed to have the highest score of androgen sensitive area of the body as well as the highest interobserver variability. The cut-off value to establish the diagnosis of hirsutism should be population-specific.