{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:35:23Z","timestamp":1779291323124,"version":"3.51.4"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"\n Importance<\/jats:title>\n Deep laryngeal involvement occurs in 10% to 40% of patients with pemphigus vulgaris and can cause life-threatening airway complications. However, fiber-optic laryngoscopy\u2014the standard detection method\u2014is invasive and causes patient discomfort. Evidence-based criteria for determining which patients require laryngoscopic examination are lacking.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To develop and internally validate a clinical prediction model for deep laryngeal involvement in patients with pemphigus vulgaris.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Retrospective cohort study of consecutive patients with pemphigus vulgaris evaluated at Rabin Medical Center, a tertiary dermatology referral center in Israel, between January 2015 and December 2022. All patients had a confirmed pemphigus vulgaris diagnosis based on clinical presentation, histopathology, and direct immunofluorescence as well as complete laryngoscopic examination data. Data analysis was performed from January to November 2024.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was deep laryngeal involvement confirmed by flexible fiber-optic laryngoscopy. A prediction model was developed using Firth penalized logistic regression with multiple imputation for missing data and bootstrap validation for internal validation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 247 patients with pemphigus vulgaris (mean [SD] age, 61.5 [15.7] years; 135 [54.7%] female), 49 (19.8%) had deep laryngeal involvement confirmed by laryngoscopy. Three clinical predictors were identified: hoarseness (odds ratio [OR], 2.50 [95% CI, 1.10-5.69]), dysphagia (OR, 6.22 [95% CI, 2.78-13.92]), and Pemphigus Disease Area Index score with a significant sex interaction (\n P<\/jats:italic>\n \u2009=\u2009.03). A simplified scoring system stratified patients into low-risk (0-1 points; 0% observed involvement), intermediate-risk (2-3 points; 15.3%), and high-risk (\u22654 points; 66.7%) categories. The model achieved an area under the receiver operating characteristic curve of 0.78 (95% CI, 0.71-0.84), with a negative predictive value of 92.6%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, the clinical prediction model using routinely assessed parameters achieved good discrimination and high negative predictive value. If externally validated, this tool may help identify low-risk patients who can safely defer laryngoscopy while prioritizing higher-risk patients for evaluation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamadermatol.2026.0391","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:31:31Z","timestamp":1775057491000},"page":"497","source":"Crossref","is-referenced-by-count":0,"title":["Predicting Laryngeal Involvement in Pemphigus Vulgaris Using a Clinical Risk Score"],"prefix":"10.1001","volume":"162","author":[{"given":"Dean","family":"Ariel","sequence":"first","affiliation":[{"name":"Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel"},{"name":"Department of Family Medicine, Clalit Health Services, Tel Aviv-Yafo District, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nir","family":"Tsur","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Rabin Medical Center \u2013 Beilinson Hospital, Petach Tikva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Mimouni","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel"},{"name":"Division of Dermatology, Rabin Medical Center \u2013 Beilinson Hospital, Petach Tikva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamir","family":"Lotan","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gal","family":"Trieman","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel"},{"name":"Department of Internal Medicine A, Beilinson Hospital, Rabin 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