Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, School of Medicine, Portland, Oregon 97239, USA.
Laryngoscope. 2012 Jan;122(1):230-6. doi: 10.1002/lary.22440. Epub 2011 Nov 17.
OBJECTIVES/HYPOTHESIS: To determine the interrater reliability of a set of postoperative endoscopic scoring parameters in patients with chronic rhinosinusitis who have undergone endoscopic sinus surgery (ESS).
Prospective cohort with retrospective review.
One hundred twenty video-endoscopic evaluations in 20 subjects recorded at 14, 30, and 45 days after ESS were scored in real time by the clinical investigators who performed the endoscopies and recorded the videos and retrospectively by an independent panel of four sinus surgeons who were blinded to all information. The scoring parameters included categoric grading for adhesion formation and middle turbinate position and continuous grading (visual analog scale) for degree of inflammation and crusting. Interrater reliability of the panel members was assessed using the Fleiss kappa test, bias index and prevalence index for categoric data, and the Shrout-Fleiss test for continuous data. The level of agreement between the panel and the real-time clinical investigator was also assessed.
For categoric variables, strong agreement between raters on the panel was found for both middle turbinate position (kappa=0.499, prevalence index=0.925) and adhesions (kappa=0.364, prevalence index=0.829). For continuous data, good agreement between raters was found for both inflammation (reliability coefficient=0.554) and crusting (reliability coefficient=0.620). Real-time investigator scoring and panel scoring showed strong agreement.
These results suggest that the endoscopic scoring parameters assessed (middle turbinate position, adhesions, inflammation, and crusting) have acceptable interexaminer reproducibility and are suitable for evaluating ESS outcomes in the postsurgical period.
目的/假设：确定一组慢性鼻-鼻窦炎患者内镜评分参数的组内可靠性，这些患者接受了内镜鼻窦手术（ESS）。
前瞻性队列研究，回顾性分析。
对 20 名患者的 120 次视频内镜评估，在 ESS 后 14、30 和 45 天进行实时评分，由进行内镜检查和记录视频的临床研究人员进行评分，并由 4 位对所有信息均不知情的鼻窦外科医生组成的独立小组进行回顾性评分。评分参数包括粘连形成和中鼻甲位置的分类评分，以及炎症和结痂程度的连续评分（视觉模拟评分）。使用 Fleiss kappa 检验、分类数据的偏倚指数和流行指数以及连续数据的 Shrout-Fleiss 检验评估小组成员的组内可靠性。还评估了小组与实时临床研究人员之间的一致性。
对于分类变量，小组内评分者之间存在较强的一致性，包括中鼻甲位置（kappa=0.499，流行指数=0.925）和粘连（kappa=0.364，流行指数=0.829）。对于连续数据，评分者之间存在较好的一致性，包括炎症（可靠性系数=0.554）和结痂（可靠性系数=0.620）。实时调查员评分和小组评分具有较强的一致性。
这些结果表明，评估的内镜评分参数（中鼻甲位置、粘连、炎症和结痂）具有可接受的组内再现性，适合评估 ESS 术后的手术结果。
