Parzefall Thomas, Wolf Axel, Frei Klemens, Kaider Alexandra, Riss Dominik
Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics and Intelligent Systems, Section of Clinical Biometrics, Medical University of Vienna, Vienna, Austria.
Int Forum Allergy Rhinol. 2017 Mar;7(3):293-299. doi: 10.1002/alr.21867. Epub 2016 Nov 2.
Use of reliable grading scores to measure epistaxis severity in hereditary hemorrhagic telangiectasia (HHT) is essential in clinical routine and for scientific purposes. For practical reasons, visual analog scale (VAS) scoring and the Epistaxis Severity Score (ESS) are widely used. VAS scores are purely subjective, and a potential shortcoming of the ESS is that it is based on self-reported anamnestic bleeding data. The aim of this study was to validate the level of correlation between VAS scores, the ESS, and actual bleeding events, based on detailed epistaxis diaries of patients.
Records from daily epistaxis diaries maintained by 16 HHT patients over 112 consecutive days were compared with the monthly ESS and daily VAS scores in the corresponding time period. The Spearman rank correlation coefficient, analysis of variance models, and multiple R measures were used for statistical analysis.
Although the ESS and VAS scores generally showed a high degree of correlation with actual bleeding events, mild events were underrepresented in both scores.
Our results highlight the usefulness of the ESS as a standard epistaxis score in cohorts with moderate to severe degrees of epistaxis. The use of detailed epistaxis diaries should be considered when monitoring patients and cohorts with mild forms of HHT.
在临床实践和科研中，使用可靠的分级评分来衡量遗传性出血性毛细血管扩张症（HHT）鼻出血的严重程度至关重要。出于实际原因，视觉模拟量表（VAS）评分和鼻出血严重程度评分（ESS）被广泛应用。VAS评分完全是主观的，而ESS的一个潜在缺点是它基于自我报告的既往出血数据。本研究的目的是根据患者详细的鼻出血日记，验证VAS评分、ESS与实际出血事件之间的相关性水平。
将16例HHT患者连续112天记录的每日鼻出血日记与同期的每月ESS评分和每日VAS评分进行比较。采用Spearman等级相关系数、方差分析模型和多重R测量进行统计分析。
尽管ESS和VAS评分总体上与实际出血事件显示出高度相关性，但在这两种评分中，轻度事件的代表性不足。
我们的结果突出了ESS作为中度至重度鼻出血患者群体鼻出血标准评分的实用性。在监测轻度HHT患者和患者群体时，应考虑使用详细的鼻出血日记。
