Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, CA, USA.
Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
Clin Otolaryngol. 2021 Jul;46(4):752-757. doi: 10.1111/coa.13727. Epub 2021 Feb 15.
The Patterson Edema scale was developed in 2007 to address the lack of a reliable, sensitive scale to measure laryngeal and pharyngeal oedema in patients with head and neck cancer. The objective of this study was to revise the existing Patterson scale to improve its reliability and utility.
Prospective investigation.
Academic medical center.
Speech-Language Pathologists, Otolaryngologists, and Radiation Oncologists.
Ratings using the Revised Patterson Edema Scale.
A consensus group reviewed existing literature regarding the performance of the original Patterson scale and revised the existing scale in regard to items to be included and descriptors for each severity level. The scale was then utilised by 18 speech language pathologists from the US and UK with >2 years-experience working with dysphagia and dysphonia with endoscopy. Each SLP rated a total of eight parameters (epiglottis, vallecula, pharyngoepiglottic folds, aryepiglottic folds, arytenoids, false vocal folds, true vocal folds and pyriform sinuses) using the Revised Patterson Edema Scale. Feedback was solicited from raters regarding areas where clarity was lacking for further scale revision. Scale revisions were completed and additional ratings were completed by otolaryngologists, radiation oncologists and less experienced SLP providers to establish reliability across disciplines. Quadratic weighted Kappa values were obtained to establish interrater reliability.
Feedback received from raters included suggestions for clarification of how to rate unilateral oedema, use of a standard task battery to visualise and rate structures consistently, and clarification of true vocal fold oedema rating parameters. Overall interrater reliability was established using quadratic weighted Kappa with good agreement noted for the epiglottis, vallecula, arytenoids and false vocal folds; moderate agreement noted for aryepiglottic folds, pharyngoepiglottic folds and pyriform sinuses; and fair agreement noted for true vocal folds.
The Revised Patterson Edema Scale demonstrates moderate-substantial interrater reliability for most parameters across multiple disciplines and experience levels, with the exception of the true vocal folds where agreement was fair. We believe the Revised Patterson Oedema Scale provides a reliable tool for clinicians and researchers to rate oedema in the supraglottic larynx and pharynx following treatment for head and neck cancer.
2007 年开发了帕特森水肿量表，以解决缺乏可靠、敏感的量表来测量头颈部癌症患者的喉和咽水肿的问题。本研究的目的是修改现有的帕特森量表，以提高其可靠性和实用性。
前瞻性研究。
学术医疗中心。
言语治疗师、耳鼻喉科医生和放射肿瘤学家。
使用修订后的帕特森水肿量表进行评分。
一个共识小组审查了关于原始帕特森量表表现的现有文献，并对现有量表进行了修订，包括纳入的项目和每个严重程度级别的描述符。然后，来自美国和英国的 18 名具有 2 年以上内镜下吞咽困难和发音困难工作经验的言语治疗师使用修订后的帕特森水肿量表对 8 个参数（会厌、 vallecula、咽会厌皱襞、杓会厌皱襞、杓状软骨、假声带、真声带和梨状隐窝）进行了评分。向评分者征求了有关清晰度不足的反馈意见，以便进一步修订量表。完成了量表修订，并由耳鼻喉科医生、放射肿瘤学家和经验较少的言语治疗师完成了额外的评分，以建立跨学科的可靠性。获得二次加权 Kappa 值以建立评分者间的可靠性。
评分者收到的反馈包括如何对单侧水肿进行评分的澄清建议、使用标准任务电池来一致地可视化和评分结构，以及对真声带水肿评分参数的澄清。使用二次加权 Kappa 获得了整体评分者间的可靠性，其中会厌、 vallecula、杓状软骨和假声带的一致性良好；杓会厌皱襞、咽会厌皱襞和梨状隐窝的一致性中等；真声带的一致性为差。
修订后的帕特森水肿量表在多个学科和经验水平上对大多数参数具有中等至显著的评分者间可靠性，除了真声带外，其一致性为差。我们认为，修订后的帕特森水肿量表为临床医生和研究人员提供了一种可靠的工具，用于在头颈部癌症治疗后评估声门上喉和咽的水肿。
