Department of Otolaryngology, University of Washington, Seattle Children's Hospital, USA.
Department of Otolaryngology, Antwerp University Hospital, University of Antwerp, Belgium.
Int J Pediatr Otorhinolaryngol. 2023 Aug;171:111627. doi: 10.1016/j.ijporl.2023.111627. Epub 2023 Jun 9.
To develop consensus statements for the scoring of pediatric drug induced sleep endoscopy in the diagnosis and management of pediatric obstructive sleep apnea.
The leadership group identified experts based on defined criteria and invited 18 panelists to participate in the consensus statement development group. A modified Delphi process was used to formally quantify consensus from opinion. A modified Delphi priori process was established, which included a literature review, submission of statements by panelists, and an iterative process of voting to determine consensus. Voting was based on a 9-point Likert scale. Statements achieving a mean score greater than 7 with one or fewer outliers were defined as reaching consensus. Statements achieving a mean score greater than 6.5 with two or fewer outliers were defined as near consensus. Statements with lower scores or more outliers were defined as no consensus.
A total of 78 consensus statements were evaluated by the panelists at the first survey - 49 achieved consensus, 18 achieved near consensus, and 11 did not achieve consensus. In the second survey, 16 statements reached consensus and 5 reached near consensus. Regarding scoring, consensus was achieved on the utilization of a 3-point Likert scale for each anatomic site for maximal observed obstructions of <50% (Score 0, no-obstruction), ≥ 50% but <90% (Score 2, partial obstruction), and ≥ 90% (Score 3, complete obstruction). Anatomic sites to be scored during DISE that reached consensus or near-consensus were the nasal passages, adenoid pad, velum, lateral pharyngeal walls, tonsils (if present), tongue base, epiglottis, and arytenoids.
This study developed consensus statements on the scoring of DISE in pediatric otolaryngology using a modified Delphi process. The use of a priori process, literature review, and iterative voting method allowed for the formal quantification of consensus from expert opinion. The results of this study may provide guidance for standardizing scoring of DISE in pediatric patients.
制定小儿药物诱导睡眠内镜检查（DISE）评分共识声明，用于小儿阻塞性睡眠呼吸暂停（OSA）的诊断和治疗。
领导小组根据既定标准确定专家，并邀请 18 名小组成员参加共识声明制定小组。采用改良 Delphi 法对意见进行正式量化，建立改良 Delphi 先验程序，包括文献回顾、小组成员提交声明和迭代投票确定共识的过程。投票基于 9 分 Likert 量表。评分大于 7 分且无离群值的声明定义为达成共识；评分大于 6.5 分且有两个或更少离群值的声明定义为接近共识；评分较低或离群值较多的声明定义为无共识。
小组成员在第一次调查中评估了 78 项共识声明，其中 49 项达成共识，18 项接近共识，11 项未达成共识。在第二次调查中，16 项声明达成共识，5 项接近共识。关于评分，对于每个解剖部位，采用 3 分 Likert 量表对最大观察到的阻塞<50%（评分 0，无阻塞）、≥50%但<90%（评分 2，部分阻塞）和≥90%（评分 3，完全阻塞）的情况达成共识。在 DISE 中需要评分的解剖部位有鼻腔、腺样体、软腭、咽侧壁、扁桃体（如有）、舌根、会厌和杓状软骨，这些部位均达成共识或接近共识。
本研究采用改良 Delphi 法制定了小儿耳鼻喉科 DISE 评分共识声明。采用先验程序、文献回顾和迭代投票方法，可对专家意见进行正式的共识量化。本研究的结果可能为规范小儿患者 DISE 评分提供指导。
