Diagnosis of Laryngomalacia by Fiberoptic Endoscopy: Results

Mar-31-2015

The mean age for patients in the study group was 4.9 months (55% male patients), and for the control subjects it was 4.4 months (52% male subjects). No procedure-related complications occurred. All patients were discharged from the hospital promptly after undergoing the WT, and 1.5 to 4.5 h after undergoing the DAT (median time, 2.1 h).
There was a high clinical agreement between investigators 1 (Y.S.) and 4 (A.D.) for the laryngo-malacia clinical scores with median scores of 8.0 for both investigators (range, 3 to 12 and 4 to 11, respectively; p = 0.36 [Wilcoxon test]). The correlations were high (Kendall coefficient of concordance, 0.932; and Spearman correlation coefficient [r value], 0.863; p < 0.0001). Similar agreements were obtained for the two components of the clinical score (ie, the history and the physical examination scores). More info
The video-scoring results are presented in Table 3. No significant differences were found between the original and the repeated video scores (ie, intrainvestigator variability), showing high accuracy and repeatability (Table 4). There were no significant differences among the three investigators (ie, interinvestigator differences) regarding all of their total and subcomponent video scores (Table 5). There was a high level of agreement among all three investigators for the video scores, including the following: (1) agreement between each two investigators; (2) agreement for arytenoid scores, epiglottic scores, and total scores; (3) agreement for both the study and control groups separately; and (4) agreement for each of the two laryngoscopic techniques separately (ie, Kendall and Spearman tests) [Table 6]. These results confirm both a high level of agreement and no significant differences among the investigators for both clinical and video assessments. The correlation between the clinical scores and the video scores was weak (DAT, r = 0.43 [p = 0.004]; WT, r = 0.31 [p = 0.044]. The correlation was strong for healthy control subjects (r > 0.84). The AUC of the receiver operating characteristic showed that the best AUC was 1.0 for the DAT and 0.95 for the WT.

Table 3—Results of the Video Scores

Variables Laryngomalacia Patients Control Subjects
DAT (n = 42) WT (n = 42) DAT (n = 13) WT (n = 12)
Total score
Median 5.0 5.0 0.0 0.0
Range (2-8) (0-7) (0-1) (0-2)
Arytenoid score
Median 2.2 2.0 0.0 0.0
Range (1-4) (0-4) (0-1) (0-1)
Epiglottic score
Median 2.8 2.5 0.0 0.0
Range (1-4) (0-4) (0-1) (0-1)

Table 4—Accuracy of the Video Scoring for Each of the Investigators for the Total Video Score and Its Two Subscores, and for All Three Investigators Combined

Score Original Score Median(Range) Repeat Score Median (Range) r Value! p Value!
Total
Mean§ 5.33 (2.3-7.7) 6.00 (2.3-7.7) 0.90 0.12
Investigator 1 5.00 (3-8) 6.00 (3-8) 0.86 0.20
Investigator 2 6.00 (2-8) 6.00 (2-8) 0.83 0.82
Investigator 3 5.00 (2-7) 6.0 (2-8) 0.84 0.025
Epiglottic
Mean§ 3.00 (1-4) 3.00 (1-4) 0.86 0.93
Investigator 1 3.00 (1-4) 3.00 (1-4) 0.82 0.71
Investigator 2 3.00 (1-4) 3.00 (1-4) 0.81 0.71
Investigator 3 3.00 (1-4) 3.00 (1-4) 0.84 1.00
Arytenoid
Mean§ 2.33(1.3-3.7) 2.67 (1.3-4.0) 0.82 0.04
Investigator 1 2.00 (1-4) 3.00 (2-4) 0.78 0.16
Investigator 2 3.00 (1-4) 3.00 (1-4) 0.75 1.00
Investigator 3 2.00 (1-3) 3.00 (1-4) 0.72 0.004

Table 5—Interinvestigator Agreement for Total Video Scores and Subcomponents

Variables Among All Three Investigators! Between Each Two Investigators!
WT DAT WT DAT
Laryngomalacia patients
Total video score 0.81 0.26 0.8-1.0 0.13-0.45
Arytenoid score 0.28 0.21 0.25-0.37 0.32-0.44
Epiglottis score 0.35 0.6 0.17-0.59 0.32-0.71
Healthy control subjects
Total video score 0.67 0.33 0.16-0.43 0.24-0.58
Arytenoid score 1.00 0.33 0.25-0.67 0.33-1.0
Epiglottis score 0.33 1.00 0.33-0.80 0.31-0.67

Table 6—Assessment of Agreement Among the Three Investigators Regarding the Video Scores

Laryngoscopy Technique Score Kendall Spearman
For both patients and control subjects (n = 109)
Investigators 1 vs 2 vs 3 1 vs 2 1 vs 3 2 vs 3
DAT Total 0.976 0.959 0.946 0.943
WT Total 0.967 0.952 0.952 0.946
DAT Epiglottic 0.969 0.969 0.963 0.928
WT Epiglottic 0.955 0.914 0.941 0.941
DAT Arytenoid 0.915 0.916 0.841 0.861
WT Arytenoid 0.912 0.915 0.848! 0.839
For patients (n = 84)
Investigators 1 vs 2 vs 3 1 vs 2 1 vs 3 2 vs 3
DAT Total 0.926 0.907 0.883! 0.876
WT Total 0.930 0.901 0.897 0.888
DAT Epiglottic 0.935 0.943 0.916 0.848
WT Epiglottic 0.916 0.836 0.905 0.880
DAT Arytenoid 0.820 0.805 0.669 0.716
WT Arytenoid 0.801 0.813 0.650 0.637
For control subjects (n = 25)
Investigators 1 vs 2 vs 3 1 vs 2 1 vs 3 2 vs 3
DAT Total 0.912 1.000 0.811 0.811
WT Total 0.914 0.810 0.991 0.775
DAT Epiglottic 1.000 1.000 1.000 1.000
WT Epiglottic 0.731 0.522 0.522 1.000
DAT Arytenoid 0.733 1.000 0,530 31.50.
WT Arytenoid 0.832 1.000! 41.70. 0.742