Department of Communication Sciences & Disorders, University of Cincinnati, Cincinnati, Ohio, USA.
J Voice. 2011 May;25(3):293-300. doi: 10.1016/j.jvoice.2009.11.009. Epub 2010 Mar 3.
To evaluate the level of agreement between reflux area index scores, the reflux symptom index (RSI), and the reflux finding score (RFS). Inter- and intrarater reliability of the RFS was assessed. A criterion of pH 5 was used to evaluate its effects on agreement.
Adult participants were enrolled in this prospective study.
Eighty-two participants (72 patients and 10 controls) completed the RSI, videoendoscopy, and 24-hour pH probe monitoring. The reflux area index for extraesophageal reflux (EER) events was calculated at pH 4 and 5. Two speech-language pathologists and one otolaryngologist independently rated 36 endoscopic examinations using the RFS through a web-based system. A repeated rating of six examinations was completed.
Chi-square revealed poor agreement between the diagnostic tools, regardless of which pH criterion was used. Intraclass correlation coefficients revealed fair interrater reliability of the RFS and moderate intrarater reliability. Independent-sample t tests for the RFS and reflux area index (RAI) scores failed to identify patients from normal controls.
The results of this study highlight the lack of agreement among the current available diagnostic tools for EER. Raters were not in agreement regarding the presence and severity of physical findings of EER. Results support the need for greater consensus among the clinical tools used in the diagnosis of EER. Physical rating scales may overidentify patients and would benefit from uniform scales and training. Assessing EER occurring at pH 5 may also yield important diagnostic information. Further research is needed to verify normative RAI cutpoints.
评估反流面积指数评分、反流症状指数（RSI）和反流发现评分（RFS）之间的一致性水平。评估 RFS 的组内和组间可靠性。使用 pH 值 5 作为标准来评估其对一致性的影响。
本前瞻性研究纳入了成年参与者。
82 名参与者（72 名患者和 10 名对照者）完成了 RSI、视频内镜检查和 24 小时 pH 探头监测。计算食管外反流（EER）事件的反流面积指数在 pH 值 4 和 5 时的情况。两名言语病理学家和一名耳鼻喉科医生通过基于网络的系统，独立使用 RFS 对 36 次内镜检查进行评分。还完成了对 6 次检查的重复评分。
无论使用哪种 pH 值标准，卡方检验都显示这些诊断工具之间的一致性较差。组内相关系数显示 RFS 的组间可靠性为中等，组内可靠性为良好。RFS 和反流面积指数（RAI）评分的独立样本 t 检验未能在正常对照者中识别出患者。
本研究结果强调了目前用于 EER 的诊断工具之间缺乏一致性。评估者对于 EER 的物理表现的存在和严重程度存在不一致意见。结果支持在 EER 诊断中使用的临床工具之间需要达成更大共识。物理评分量表可能会过度识别患者，并且会受益于统一的量表和培训。评估 pH 值 5 时的 EER 也可能产生重要的诊断信息。需要进一步的研究来验证正常 RAI 切点。
