Kumar Divjot S, Valenzuela Dianne, Kozak Frederick K, Ludemann Jeffrey P, Moxham J Paul, Lea Jane, Chadha Neil K
Medical student at University of British Columbia, British Columbia, Canada.
University of British Columbia, British Columbia, Canada3Division of Pediatric Otolaryngology, British Columbia Children's Hospital, British Columbia, Canada.
JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):1034-7. doi: 10.1001/jamaoto.2014.2338.
Because tonsillar enlargement can have substantial ill health effects in children, reliable monitoring and documentation of tonsil size is necessary in clinical settings. Tonsil grading scales potentially allow clinicians to precisely record and communicate changes in tonsil size, but their reliability in a clinical setting has not been studied.
To assess the interobserver and intraobserver reliability of the Brodsky and Friedman tonsil size grading scales and a novel 3-grade scale.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study between June 2012 and August 2013 at a tertiary pediatric otolaryngology outpatient clinic at British Columbia Children's Hospital. We recruited 116 children, aged 3 to 14 years, with no major craniofacial abnormalities. For each child, 2 separate tonsil assessments (with at least a 5-minute interval in between) were conducted by 4 independent observers: 2 staff pediatric otolaryngologists, 1 otolaryngology trainee (fellow or resident), and 1 medical student. Each observer assessed and graded tonsil sizes using 3 different scales.
Interobserver and intraobserver reliabilities were assessed by deriving the intraclass correlation coefficients (ICCs) and Pearson correlation coefficients, respectively. To discount for any asymmetric scores, all data analysis was conducted on the left tonsil measurement only.
Mean interobserver reliability was highest for the Brodsky grading scale (ICC, 0.721; Cronbach α, 0.911), followed by the Friedman grading scale (ICC, 0.647; Cronbach α, 0.879) and the 3-grade scale (ICC, 0.599; Cronbach α, 0.857). The mean intraobserver reliabilities for the Brodsky, Friedman, and modified 3-grade scales were 0.954, 0.932, and 0.927, respectively.
The Brodsky grading scale offered the highest interobserver and intraobserver reliability when compared with the Friedman and novel 3-grade scales. The results of this study would support the uniform use of the Brodsky scale for future clinical and research work.
由于扁桃体肿大可对儿童健康产生重大不良影响，因此在临床环境中，可靠地监测和记录扁桃体大小很有必要。扁桃体分级量表可能使临床医生能够精确记录并交流扁桃体大小的变化，但其在临床环境中的可靠性尚未得到研究。
评估布罗德斯基（Brodsky）和弗里德曼（Friedman）扁桃体大小分级量表以及一种新型三级量表的观察者间和观察者内可靠性。
设计、地点和参与者：2012年6月至2013年8月在不列颠哥伦比亚省儿童医院的三级儿科耳鼻喉科门诊进行的横断面研究。我们招募了116名3至14岁、无重大颅面异常的儿童。对于每个儿童，由4名独立观察者进行2次单独的扁桃体评估（中间间隔至少5分钟）：2名儿科耳鼻喉科 staff 医生、1名耳鼻喉科实习生（研究员或住院医生）和1名医学生。每位观察者使用3种不同的量表对扁桃体大小进行评估和分级。
分别通过计算组内相关系数（ICC）和皮尔逊相关系数来评估观察者间和观察者内的可靠性。为消除任何不对称分数的影响，所有数据分析仅基于左侧扁桃体测量值进行。
布罗德斯基分级量表的平均观察者间可靠性最高（ICC，0.721；克朗巴赫α系数，0.911），其次是弗里德曼分级量表（ICC，0.647；克朗巴赫α系数，0.879）和三级量表（ICC，0.599；克朗巴赫α系数，0.857）。布罗德斯基、弗里德曼和改良三级量表的平均观察者内可靠性分别为0.954、0.932和0.927。
与弗里德曼和新型三级量表相比，布罗德斯基分级量表具有最高的观察者间和观察者内可靠性。本研究结果将支持在未来的临床和研究工作中统一使用布罗德斯基量表。
