Royal National Throat Nose & Ear Hospital, 330 Grays Inn Rd., Kings Cross, London, WC1X 8DA, England.
Sleep Breath. 2020 Dec;24(4):1685-1693. doi: 10.1007/s11325-020-02035-y. Epub 2020 Mar 2.
A new classification system is proposed to help the interpretation of drug-induced sleep endoscopy (DISE). The purpose is to create a classification system that improves upon existing systems designed to assess suitability of lateral wall surgery such as expansion pharyngoplasty whilst improving the reliability of the classification.
A qualitative study into the difficulties trainees had with existing systems was used to identify key issues that needed to be addressed. A visual description of the palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis (PTLTbE) classification was developed. Preliminary data on the inter-rater reliability of PTLTbE were collected. Twenty junior doctors were asked to interpret 5 DISE videos using the PTLTbE classification, and the kappa and percentage agreement were calculated.
The Krippendorff alpha ranged between 0.56 and 0.86 for individual DISE videos which compared favourably with the results from those who also completed the VOTE classification (range 0.31 to 0.66). The overall percentage agreement for PTLTbE was 90.1%.
There are a number of advantages of the PTLTbE system over other existing DISE classifications. (1) Tonsillar obstruction is separated from lateral pharyngeal wall collapse. (2) Interobserver reliability is improved, critical to improve communication, patient outcomes and future research. (3) The learning curve to use this system is short. Most doctors did not need to refer to the classification images as an aide-memoire after a few uses of the PTLTbE system. A fuller examination of the reliability of the PTLTbE system is underway along with examination of its use in clinical settings.
提出一种新的分类系统，以帮助解读药物诱导睡眠内镜（DISE）。目的是创建一个分类系统，在评估侧墙手术（如扩张咽成形术）适用性的现有系统的基础上进行改进，同时提高分类的可靠性。
对学员在使用现有系统时遇到的困难进行定性研究，以确定需要解决的关键问题。开发了一种关于腭、扁桃体、侧咽壁、舌基、会厌（PTLTbE）的视觉描述分类系统。收集了 PTLTbE 初步的组内可靠性数据。20 名初级医生被要求使用 PTLTbE 分类来解释 5 个 DISE 视频，计算kappa 和百分比一致性。
单个 DISE 视频的 Krippendorff alpha 范围为 0.56 至 0.86，与完成 VOTE 分类的人的结果（范围为 0.31 至 0.66）相比，结果较好。PTLTbE 的总体百分比一致性为 90.1%。
与其他现有的 DISE 分类系统相比，PTLTbE 系统有几个优点。（1）扁桃体阻塞与侧咽壁塌陷分开。（2）提高了观察者间的可靠性，对于改善沟通、患者结局和未来研究至关重要。（3）使用该系统的学习曲线较短。大多数医生在使用 PTLTbE 系统几次后，不需要参考分类图像作为记忆辅助。正在对 PTLTbE 系统的可靠性进行更全面的检查，并检查其在临床环境中的应用。
