Nacci Andrea, Bastiani Luca, Barillari Maria Rosaria, Lechien Jerome R, Martinelli Massimo, Bortoli Nicola De, Berrettini Stefano, Fattori Bruno
ENT Audiology Phoniatric Unit, University of Pisa, Pisa, Italy.
Laryngopharyngeal Reflux Study Group of YO-IFOS, Paris, France.
Ann Otol Rhinol Laryngol. 2020 Oct;129(10):1020-1029. doi: 10.1177/0003489420930034. Epub 2020 May 29.
To investigate the psychometric properties of the reflux symptom index (RSI) as short screening approach for the diagnostic of laryngopharyngeal reflux (LPR) in patients with confirmed diagnosed regarding the 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH).
From January 2017 to December 2018, 56 patients with LPR symptoms and 71 healthy individuals (control group) were prospectively enrolled. The LPR diagnosis was confirmed through MII-pH results. All subjects (n = 127) fulfilled RSI and the Reflux Finding Score (RFS) was performed through flexible fiberoptic endoscopy. The sensitivity and the specificity of RSI was assessed by ROC (Receiver Operating Characteristic) analysis.
A total of 15 LPR patients (26.8%) of the clinical group met MII-pH diagnostic criteria. Among subjects classified as positive for MII- pH diagnoses, RSI and RFS mean scores were respectively 20 (SD ± 10.5) and 7.1 (SD ± 2.5), values not significantly different compared to the negative MII-pH group. The metric analysis of the items led to the realization of a binary recoding of the score. Both versions had similar psychometric properties, α was 0.840 for RSI original version and 0.836 for RSI binary version. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without LPR pathology diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for LPR pathology were ≥ 5 for RSI binary version and ≥ 15 for RSI original version. Both version overestimated LPR prevalence. The original version had more sensitivity and the RSI Binary version had more specificity.
It would be necessary to think about modifying the original RSI in order to improve its sensitivity and specificity (RSI binary version, adding or changing some items), or to introduce new scores in order to better frame the probably affected of LPR patient.
对于经24小时多通道腔内阻抗-pH监测（MII-pH）确诊的患者，研究反流症状指数（RSI）作为喉咽反流（LPR）诊断的简短筛查方法的心理测量特性。
2017年1月至2018年12月，前瞻性纳入56例有LPR症状的患者和71名健康个体（对照组）。通过MII-pH结果确诊LPR。所有受试者（n = 127）均完成RSI，并通过可弯曲纤维喉镜进行反流发现评分（RFS）。通过ROC（受试者工作特征）分析评估RSI的敏感性和特异性。
临床组共有15例LPR患者（26.8%）符合MII-pH诊断标准。在MII-pH诊断为阳性的受试者中，RSI和RFS的平均得分分别为20（标准差±10.5）和7.1（标准差±2.5），与MII-pH阴性组相比，差异无统计学意义。对项目的计量分析导致对分数进行二元重新编码。两个版本具有相似的心理测量特性，RSI原始版本的α为0.840，RSI二元版本的α为0.836。较高且相当的曲线下面积（AUC）值表明两个量表都有很好的能力区分有和没有LPR病理诊断的个体。基于平衡的敏感性和特异性，LPR病理的最佳截断分数对于RSI二元版本为≥5，对于RSI原始版本为≥15。两个版本均高估了LPR患病率。原始版本敏感性更高，RSI二元版本特异性更高。
有必要考虑修改原始RSI以提高其敏感性和特异性（RSI二元版本，添加或更改一些项目），或者引入新的评分以更好地界定LPR患者可能受影响的情况。
