Reliability of peak expiratory flow percentage compared to endoscopic grading in subglottic stenosis
© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society..
OBJECTIVE: To determine the reliability of pulmonary function testing compared to endoscopic grading in the assessment of subglottic stenosis.
METHODS: Consecutively treated patients with subglottic stenosis at a tertiary care specialty hospital from 2009 to 2019 were identified. Two fellowship-trained laryngologists and two otolaryngologists blinded to clinical history reviewed laryngo tracheoscopic examinations and assessed the degree of stenosis using the Cotton-Myer grading system (% stenosis). Nine full flow-volume loops were performed at the time of each exam.
RESULTS: The endoscopic images of 45 subjects were graded for degree of stenosis and the spirometry data were analyzed. The kappa values for Cotton-Myer grade overall was 0.37, grade I was -0.103, grade II was 0.052, and grade III was 0.045. The overall intraclass correlation of the physician grading of estimated percent obstruction (% stenosis) was 0.712 (P < .01) whereas the overall intraclass correlation for PEF% was 0.96 (P < .01). Within each Cotton-Myer grade, the intraclass correlation for % stenosis was 0.45 (P = .02) for grade I, 0.06 (P = .30) for grade II, and 0.16 (P = .03) for grade III. The intraclass correlation for PEF% for grade I was 0.97 (P < .01), grade II was 0.92 (P < .01), and grade III was 0.96 (P < .01).
CONCLUSION: Cotton-Myer grading and estimating percent obstruction (% stenosis) for adult subglottic stenosis showed poor reliability as an assessment tool compared to the excellent intraclass correlation seen with pulmonary function tests within each Cotton-Myer grade subgroup. We recommend pulmonary function testing, specifically PEF% because it is a normalized value, for the assessment and management of subglottic stenosis.
LEVEL OF EVIDENCE: 4.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:5 |
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| Enthalten in: |
Laryngoscope investigative otolaryngology - 5(2020), 6 vom: 19. Dez., Seite 1133-1139 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Song, Sungjin A [VerfasserIn] |
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| Links: |
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| Themen: |
Cotton‐Myer grading |
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| Anmerkungen: |
Date Revised 30.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1002/lio2.492 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM319287084 |
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| 500 | |a Date Revised 30.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society. | ||
| 520 | |a OBJECTIVE: To determine the reliability of pulmonary function testing compared to endoscopic grading in the assessment of subglottic stenosis | ||
| 520 | |a METHODS: Consecutively treated patients with subglottic stenosis at a tertiary care specialty hospital from 2009 to 2019 were identified. Two fellowship-trained laryngologists and two otolaryngologists blinded to clinical history reviewed laryngo tracheoscopic examinations and assessed the degree of stenosis using the Cotton-Myer grading system (% stenosis). Nine full flow-volume loops were performed at the time of each exam | ||
| 520 | |a RESULTS: The endoscopic images of 45 subjects were graded for degree of stenosis and the spirometry data were analyzed. The kappa values for Cotton-Myer grade overall was 0.37, grade I was -0.103, grade II was 0.052, and grade III was 0.045. The overall intraclass correlation of the physician grading of estimated percent obstruction (% stenosis) was 0.712 (P < .01) whereas the overall intraclass correlation for PEF% was 0.96 (P < .01). Within each Cotton-Myer grade, the intraclass correlation for % stenosis was 0.45 (P = .02) for grade I, 0.06 (P = .30) for grade II, and 0.16 (P = .03) for grade III. The intraclass correlation for PEF% for grade I was 0.97 (P < .01), grade II was 0.92 (P < .01), and grade III was 0.96 (P < .01) | ||
| 520 | |a CONCLUSION: Cotton-Myer grading and estimating percent obstruction (% stenosis) for adult subglottic stenosis showed poor reliability as an assessment tool compared to the excellent intraclass correlation seen with pulmonary function tests within each Cotton-Myer grade subgroup. We recommend pulmonary function testing, specifically PEF% because it is a normalized value, for the assessment and management of subglottic stenosis | ||
| 520 | |a LEVEL OF EVIDENCE: 4 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cotton‐Myer grading | |
| 650 | 4 | |a laryngotracheal stenosis | |
| 650 | 4 | |a pulmonary function testing | |
| 650 | 4 | |a subglottic stenosis | |
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| 700 | 1 | |a Franco, Ramon A |c Jr |e verfasserin |4 aut | |
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