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Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction

The current gold-standard method for diagnosing exercise-induced laryngeal obstruction (EILO) is continuous laryngoscopy during exercise (CLE), with severity classified by a visual grade scoring system. We evaluated the precision of this approach, by evaluating test–retest reliability of CLE and bot...

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Autores principales: Walsted, Emil Schwarz, Hull, James H., Hvedstrup, Jeppe, Maat, Robert Christiaan, Backer, Vibeke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532755/
https://www.ncbi.nlm.nih.gov/pubmed/28765826
http://dx.doi.org/10.1183/23120541.00070-2017
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author Walsted, Emil Schwarz
Hull, James H.
Hvedstrup, Jeppe
Maat, Robert Christiaan
Backer, Vibeke
author_facet Walsted, Emil Schwarz
Hull, James H.
Hvedstrup, Jeppe
Maat, Robert Christiaan
Backer, Vibeke
author_sort Walsted, Emil Schwarz
collection PubMed
description The current gold-standard method for diagnosing exercise-induced laryngeal obstruction (EILO) is continuous laryngoscopy during exercise (CLE), with severity classified by a visual grade scoring system. We evaluated the precision of this approach, by evaluating test–retest reliability of CLE and both inter- and intra-rater variability. In this prospective case–control study, subjects completed four consecutive treadmill CLE tests under identical conditions. Laryngoscopic video recordings were anonymised and graded by three expert raters. 2 months following initial scoring, videos were re-randomised and rating repeated to assess intra-rater agreement. 20 subjects (16 cases and four controls) completed four CLE tests. The time to exhaustion increased by 30 s (95% CI 0.02–57.8, p<0.05) in the second CLE compared with the first test, but remained identical in the subsequent tests. Only one-third of subjects retained their initial diagnosis in the subsequent three tests. Inter-rater agreement on grade scores (weighted Cohen's ϰ) was 0.16–0.45, while intra-rater agreement ranged from 0.30 to 0.67. The CLE test is key in the diagnostic assessment of patients with EILO. However, the widely adopted visual grade scoring system does not appear to be a robust means for reliably classifying severity of EILO.
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spelling pubmed-55327552017-08-01 Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction Walsted, Emil Schwarz Hull, James H. Hvedstrup, Jeppe Maat, Robert Christiaan Backer, Vibeke ERJ Open Res Original Articles The current gold-standard method for diagnosing exercise-induced laryngeal obstruction (EILO) is continuous laryngoscopy during exercise (CLE), with severity classified by a visual grade scoring system. We evaluated the precision of this approach, by evaluating test–retest reliability of CLE and both inter- and intra-rater variability. In this prospective case–control study, subjects completed four consecutive treadmill CLE tests under identical conditions. Laryngoscopic video recordings were anonymised and graded by three expert raters. 2 months following initial scoring, videos were re-randomised and rating repeated to assess intra-rater agreement. 20 subjects (16 cases and four controls) completed four CLE tests. The time to exhaustion increased by 30 s (95% CI 0.02–57.8, p<0.05) in the second CLE compared with the first test, but remained identical in the subsequent tests. Only one-third of subjects retained their initial diagnosis in the subsequent three tests. Inter-rater agreement on grade scores (weighted Cohen's ϰ) was 0.16–0.45, while intra-rater agreement ranged from 0.30 to 0.67. The CLE test is key in the diagnostic assessment of patients with EILO. However, the widely adopted visual grade scoring system does not appear to be a robust means for reliably classifying severity of EILO. European Respiratory Society 2017-07-28 /pmc/articles/PMC5532755/ /pubmed/28765826 http://dx.doi.org/10.1183/23120541.00070-2017 Text en Copyright ©ERS 2017 http://creativecommons.org/licenses/by-nc/4.0/ This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
spellingShingle Original Articles
Walsted, Emil Schwarz
Hull, James H.
Hvedstrup, Jeppe
Maat, Robert Christiaan
Backer, Vibeke
Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
title Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
title_full Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
title_fullStr Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
title_full_unstemmed Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
title_short Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
title_sort validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532755/
https://www.ncbi.nlm.nih.gov/pubmed/28765826
http://dx.doi.org/10.1183/23120541.00070-2017
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