Koo Soo Kweon, Lee Sang Hoon, Koh Tae Kyung, Kim Young Jun, Moon Ji Seung, Lee Ho Byung, Park Geun Hyung
Department Otorhinolaryngology-Head and Neck Surgery, Busan Saint Mary's Hospital, 538-41 Yongho-dong, Nam-gu, Busan, South Korea.
Eur Arch Otorhinolaryngol. 2019 May;276(5):1525-1531. doi: 10.1007/s00405-019-05386-9. Epub 2019 Mar 18.
An ideal, drug-induced sleep endoscopy (DISE) classification system should cover all the upper airways, be simple and practical, and quantify the severity of any obstruction. Excellent validity and reliability are essential. We explored the inter-rater reliability of Koo's DISE classification system in the hands of experienced and inexperienced otolaryngologists.
We retrospectively analyzed video images of 100 patients who underwent DISE examination in our hospital between 2015 and 2018. Three experienced and three inexperienced otolaryngologists reviewed and scored all images. We calculated the inter-rater reliabilities of the two groups of otolaryngologists.
Independent of the extent of experience with DISE, detection of retropalatal obstructions (overall agreement: 0.87; kappa value: 0.60), and the degree of such obstructions (overall agreement: 0.67; kappa value: 0.52) were more consistent than were the detection of retrolingual obstructions (overall agreement: 0.61, kappa value: 0.37) and the degree of retrolingual obstructions (overall agreement: 0.20, kappa value: 0.35). Inexperienced observers were in good agreement for palatal obstructions and experienced observers were in good agreement for tongue-base obstructions. All of the otolaryngologists found it difficult to detect a lateral pharyngeal wall obstruction at the retrolingual level.
Koo's DISE classification system focuses on surgical treatment, especially by otolaryngologists, and the degree of agreement between the experienced and inexperienced observers was relatively high. The participants' level of experience had a strong impact on scoring. The less-experienced otolaryngologists tended to overlook tongue-base obstructions, focusing instead on relatively simple retropalatal obstructions. In the future, development of a DISE classification system that can be accepted globally will be necessary.
一个理想的药物诱导睡眠内镜检查（DISE）分类系统应涵盖所有上气道，简单实用，并能对任何阻塞的严重程度进行量化。良好的有效性和可靠性至关重要。我们探讨了Koo的DISE分类系统在经验丰富和经验不足的耳鼻喉科医生手中的评分者间可靠性。
我们回顾性分析了2015年至2018年在我院接受DISE检查的100例患者的视频图像。三名经验丰富和三名经验不足的耳鼻喉科医生对所有图像进行了评估和评分。我们计算了两组耳鼻喉科医生的评分者间可靠性。
无论DISE经验程度如何，软腭后阻塞的检测（总体一致性：0.87；kappa值：0.60）及其阻塞程度（总体一致性：0.67；kappa值：0.52）比舌后阻塞的检测（总体一致性：0.61，kappa值：0.37）和舌后阻塞程度（总体一致性：0.20，kappa值：0.35）更具一致性。经验不足的观察者对腭部阻塞的判断一致性良好，经验丰富的观察者对舌根阻塞的判断一致性良好。所有耳鼻喉科医生都发现很难检测到舌后水平的咽侧壁阻塞。
Koo的DISE分类系统侧重于手术治疗，尤其是耳鼻喉科医生的手术治疗，经验丰富和经验不足的观察者之间的一致性程度相对较高。参与者的经验水平对评分有很大影响。经验较少的耳鼻喉科医生往往会忽略舌根阻塞，而将注意力集中在相对简单的软腭后阻塞上。未来，有必要开发一种全球通用的DISE分类系统。
