Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
West Virginia Clinical and Translational Science Institute, West Virginia University Health Sciences Center Erma Byrd Biomedical Research Center, Morgantown, WV, USA.
Int J Pediatr Otorhinolaryngol. 2022 Nov;162:111284. doi: 10.1016/j.ijporl.2022.111284. Epub 2022 Aug 17.
The surgical management of Obstructive Sleep Apnea (OSA) may be guided by Drug Induced Sleep Endoscopy (DISE), but there is no universally accepted scoring system for DISE in children. The purpose of this study is to compare a novel system to the more commonly used VOTE (Velum, Oropharynx, Tongue base, Epiglottis) system.
A total of thirty pediatric DISE videos were reviewed and scored twice by 5 raters with a range of experience levels. The videos were scored using both the VOTE and the new scoring systems. The raters were also asked to recommend surgical intervention based on the DISE exam alone. Intra-rater test-retest analysis of the responses was conducted using weighted kappa (WK) statistic and percentage agreement (PA), respectively. Inter-rater reliability analysis of responses was evaluated using Krippendorff's alpha reliability coefficient (KA). Using a proportional odds model, a comparison of the weighted kappa statistic for the VOTE and the novel scoring systems was conducted.
For the novel scoring system, the intra-rater test-retest WK coefficient was 0.62 and 0.87 and the PA was 64% and 82% at the 25th and 75th percentiles, respectively. For the VOTE system, the intra-rater test-retest WK coefficient was 0.50 and 1.00 and PA was 75% and 100% at the 25th and 75th percentiles, respectively. KA was 0.36 and 0.77 at the 25th and 75th percentiles. In addition, responses to the surgical intervention survey analysis yielded a test-retest WK coefficient of 0.40 and 1.00 and a PA 71%-100% at the 25th and 75th percentiles, respectively. KA was 0.40 and 0.61 at the 25th and 75th percentiles, respectively. There was no significant difference between the 2 scoring systems on the WK statistic (p = .15), but significant difference on PA (p = .01).
Our novel scoring system demonstrated intra-rater test-retest and inter-rater reliability similar to the VOTE system, includes more sites of potential airway obstruction, and has potential for widespread use.
阻塞性睡眠呼吸暂停（OSA）的手术治疗可以通过药物诱导睡眠内窥镜检查（DISE）来指导，但目前还没有普遍接受的儿童 DISE 评分系统。本研究的目的是比较一种新的系统与更常用的 VOTE（悬雍垂、口咽、舌基、会厌）系统。
总共对 30 个儿科 DISE 视频进行了回顾，并由 5 名不同经验水平的评分者进行了两次评分。视频使用 VOTE 和新评分系统进行了评分。评分者还被要求仅根据 DISE 检查推荐手术干预。使用加权 Kappa（WK）统计和百分比一致性（PA）分别对反应进行了内部评分者测试-再测试分析。使用 Krippendorff 的 alpha 可靠性系数（KA）对反应的内部评分者可靠性进行了评估。使用比例优势模型，对 VOTE 系统和新评分系统的加权 Kappa 统计进行了比较。
对于新的评分系统，内部评分者测试-再测试 WK 系数分别为 0.62 和 0.87，第 25 和 75 百分位的 PA 分别为 64%和 82%。对于 VOTE 系统，内部评分者测试-再测试 WK 系数分别为 0.50 和 1.00，第 25 和 75 百分位的 PA 分别为 75%和 100%。KA 分别为 0.36 和 0.77。此外，手术干预调查分析的反应产生了测试-再测试 WK 系数分别为 0.40 和 1.00，第 25 和 75 百分位的 PA 分别为 71%-100%。KA 分别为 0.40 和 0.61。在 WK 统计数据上，两种评分系统之间没有显著差异（p=0.15），但在 PA 上有显著差异（p=0.01）。
我们的新评分系统显示出与 VOTE 系统相似的内部评分者测试-再测试和内部评分者可靠性，包括更多潜在气道阻塞部位，具有广泛应用的潜力。
