Wu Peng, Wang Zhenzhen, Zhang Lu, Huang Zhenxiao, Luo Yamei, Li Huijuan, Zhang Linghao, Liao Zhisu
Department of Otorhinolaryngology of First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Feb;50(2):151-4.
To validate the discharge, inflammation, polyps/edema (DIP) scoring system for the assessment of endoscopic sinus surgery (ESS) outcomes in patients with chronic rhinosinusitis (CRS).
Thirty patients with CRS were included in this prospective study. All patients were evaluated before and 2 months after surgery. Baseline measures and postoperative outcomes were evaluated using sino-nasal outcome test-20 (SNOT-20), visual analogue scale (VAS) symptom score and Lund-Mackay CT score (in baseline only). All endoscopic videos were recorded before surgery and in the end of follow-up. All videos were scored blindly by two rhinologistis using the DIP and Lund-Kennedy system for investigating the inter-rater and test-retest reliability, as well as the correlations with the existing subjective and objective scoring systems.SPSS17.0 software was used to analyze the data.
The average scores of VAS, SNOT-20, Lund-Kennedy, and DIP before and after surgery were listed below. Baseline, 29.73 ± 13.05, 24.43 ± 13.76, 7.70 ± 3.25 and 32.67 ± 13.48. Post-surgical, 13.60 ± 8.67, 10.40 ± 7.45, 5.03 ± 2.04 and 16.97 ± 8.37. All scores were declined significantly from baseline (t value were 7.43, 6.49, 6.88 and 10.93, all P < 0.001). The DIP system showed a higher inter-rater and rest-rest reliability than Lund-Kennedy system (interclass coefficient,ICC > 0.75). The Pearson analysis revealed that VAS scores were significantly correlated with SNOT-20 scores both in baseline and post-surgical assessments (r = 0.518 6, P = 0.003, and r = 0.546 7, P = 0.000). Before surgery, Lund-Kennedy scores were significantly correlated with DIP and Lund-Mackay CT scores (r = 0.937 5, P = 0.000 and r = 0.748 0, P = 0.000). DIP scores were significantly correlated with Lund-Mackay CT scores (r = 0.712 2, P = 0.000). After surgery,DIP scores were significantly correlated with Lund-Kennedy scores (r = 0.869 6, P = 0.000). But there were no significant correlations between subjective scores (VAS and SNOT-20) and objective scores (Lund-Kennedy, DIP and Lund-Mackay CT), (all P > 0.05).
The DIP scoring system shows substantial inter-rater and test-retest reliability.It is also significantly correlated with existing objective scoring parameters. It is suitable and reliable to use.
验证用于评估慢性鼻-鼻窦炎（CRS）患者内镜鼻窦手术（ESS）疗效的出院、炎症、息肉/水肿（DIP）评分系统。
本前瞻性研究纳入30例CRS患者。所有患者在手术前及术后2个月接受评估。使用鼻-鼻窦结局测试-20（SNOT-20）、视觉模拟量表（VAS）症状评分和Lund-Mackay CT评分（仅在基线时）评估基线指标和术后结局。所有内镜视频在手术前及随访结束时进行记录。两位鼻科医生使用DIP和Lund-Kennedy系统对所有视频进行盲法评分，以研究评分者间信度和重测信度，以及与现有的主观和客观评分系统的相关性。使用SPSS17.0软件分析数据。
手术前后VAS、SNOT-20、Lund-Kennedy和DIP的平均评分如下。基线时分别为29.73±13.05、24.43±13.76、7.70±3.25和32.67±13.48。术后分别为13.60±8.67、10.40±7.45、5.03±2.04和16.97±8.37。所有评分均较基线显著下降（t值分别为7.43、6.49、6.88和10.93，均P<0.001）。DIP系统显示出比Lund-Kennedy系统更高的评分者间信度和重测信度（组内相关系数，ICC>0.75）。Pearson分析显示，在基线和术后评估中，VAS评分与SNOT-20评分均显著相关（r=0.518 6，P=0.003，r=0.546 7，P=0.000）。手术前，Lund-Kennedy评分与DIP和Lund-Mackay CT评分显著相关（r=0.937 5，P=0.000和r=0.748 0，P=0.000）。DIP评分与Lund-Mackay CT评分显著相关（r=0.712 2，P=0.000）。手术后，DIP评分与Lund-Kennedy评分显著相关（r=0.869 6，P=0.000）。但主观评分（VAS和SNOT-20）与客观评分（Lund-Kennedy、DIP和Lund-Mackay CT）之间无显著相关性（均P>0.05）。
DIP评分系统显示出较高程度一致性的评分者间信度和重测信度。它也与现有的客观评分参数显著相关。其使用是合适且可靠的。
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