Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD.
Johns Hopkins University, Baltimore, MD.
Am J Rhinol Allergy. 2024 Jan;38(1):38-46. doi: 10.1177/19458924231207137. Epub 2023 Oct 11.
The Epistaxis Severity Score (ESS) is the gold-standard patient-reported outcome measure for evaluating nosebleed severity in patients with hereditary hemorrhagic telangiectasia (HHT). To date, the ESS has been assessed only for content validity and concurrent validity.
We evaluate the internal consistency and test-retest reliability of the ESS.
After receiving institutional review board approval, we sent an online survey battery, including the ESS survey, to 305 (39% male) English-speaking HHT patients ≥18 years old at a single center. Of those, 140 (46%) patients completed the battery, and 110/140 (79%) reported epistaxis. Cronbach's alpha and correlation analyses were used to evaluate internal consistency. For the test-retest reliability evaluation, we recruited 69 HHT patients during HHT clinic to complete 2 self-administered ESS surveys 2 weeks apart. Participants also completed a modified Clinical Global Impression-Improvement scale with readministration of the ESS survey. We calculated the intraclass correlation coefficient in a 2-way mixed model with absolute agreement.
The ESS survey demonstrated low internal consistency (Cronbach's alpha = 0.495), suggesting that it measured multiple unrelated concepts. Factor analysis revealed 3 latent factors with moderate intercorrelation, suggesting the presence of 3 related but distinct constructs underlying the ESS. However, the ESS demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.955; 95% CI, 0.91-0.98).
Although the ESS demonstrates high test-retest reliability, it may not adequately assess different dimensions of nosebleed severity. Additional correlated survey questions and sub-scores may be needed to increase internal consistency to accurately measure each component of epistaxis severity. It is necessary to acknowledge epistaxis severity from different dimensions and to consider evaluating individual ESS items separately for a comprehensive understanding.
《鼻出血严重程度评分（ESS）》是评估遗传性出血性毛细血管扩张症（HHT）患者鼻出血严重程度的金标准患者报告结局测量工具。迄今为止，ESS 仅评估了内容效度和同时效度。
我们评估 ESS 的内部一致性和重测信度。
在获得机构审查委员会批准后，我们向单一中心的 305 名（39%为男性）讲英语的 HHT 患者发送了在线调查包，其中包括 ESS 调查。在这些患者中，有 140 名（46%）患者完成了调查包，其中 110/140 名（79%）报告了鼻出血。我们使用 Cronbach's alpha 和相关分析来评估内部一致性。对于重测信度评估，我们招募了 69 名 HHT 患者在 HHT 诊所完成了 2 次相隔 2 周的自我管理的 ESS 调查。参与者还完成了一项改良的临床总体印象-改善量表，同时重新进行了 ESS 调查。我们使用具有绝对一致性的 2 方式混合模型计算了组内相关系数。
ESS 调查显示出较低的内部一致性（Cronbach's alpha=0.495），表明它测量了多个不相关的概念。因子分析显示存在 3 个潜在因子，具有中度相关性，表明 ESS 背后存在 3 个相关但不同的结构。然而，ESS 显示出极好的重测信度（组内相关系数=0.955；95%置信区间，0.91-0.98）。
尽管 ESS 显示出较高的重测信度，但它可能无法充分评估鼻出血严重程度的不同维度。需要增加相关的调查问题和子评分以提高内部一致性，从而准确测量鼻出血严重程度的每个组成部分。有必要从不同维度来认识鼻出血的严重程度，并考虑分别评估每个 ESS 项目，以全面了解。
