视频荧光屏检查结果主观和客观判读的评分者之间的可靠性和临床相关性

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-07-03 DOI:10.1002/lio2.1298

Jonna Kuuskoski MD, Jaakko Vanhatalo MD, Jussi Hirvonen MD, PhD, Jami Rekola MD, PhD, Leena-Maija Aaltonen MD, PhD, Pia Järvenpää MD, PhD

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引用次数: 0

摘要

背景吞咽困难通常使用视频荧光镜（VFS）进行评估。由于其评级通常是主观的正常-不正常评级，因此开发了客观测量方法。我们比较了普通 VFS 评级与客观测量 VFS 评级的评分者间可靠性，并评估了两者的临床相关性。方法两名双盲评分员分析了 77 名患者 VFS 的主观正常-正常评分。另外两名盲评定者分析了咽部充气面积（PAhold）、吞咽过程中残留咽部充气面积（PAmax）、咽部收缩比（PCR）、咽食管段最大开放度（PESmax）、咽食管段开放持续时间（POD）、气道关闭持续时间（ACD）和咽部总通过时间（TPT）的客观测量值。我们评估了主观评分和客观测量的评分者之间的一致性。临床效用分析将测量结果与 VFS 发现的咽相异常、穿透/吸气和环咽松弛进行了比较。结果在咽部检查结果方面，主观分析评分者之间的一致性主要为中等至较高。咽残留物和穿透/吸气结果的一致性最强。客观测量的评分者之间的一致性一般到良好。临床效用分析发现，TPT 与咽相异常、PCR 正常与穿透/吸气不足、PESmax 正常与环咽松弛正常之间存在统计学意义上的显著联系。结论主观分析的咽部 VFS 结果，尤其是咽部残留物和穿透/吸气检测方面的结果，评分者之间具有中等到较高的一致性，这反映了吞咽的有效性和安全性。客观测量结果在观察者之间的再现性一般到良好，因此可以提高 VFS 诊断的可靠性。证据等级 4。

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Inter-rater reliability and clinical relevance of subjective and objective interpretation of videofluoroscopy findings

Background

Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal-abnormal ratings, objective measurements have been developed. We compared the inter-rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance.

Methods

Two blinded raters analyzed the subjective normal-abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter-rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation.

Results

In the pharyngeal findings, the subjective analysis inter-rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter-rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation.

Conclusions

The subjective analysis had moderate to strong inter-rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter-observer reproducibility and could thus improve the reliability of VFS diagnostics.