The validity of nasal endoscopy in patients with chronic rhinosinusitis

An inter-rater agreement study

K. L. Larsen, B. Lange, P. Darling, G. Jørgensen, A. D. Kjeldsen*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Objectives: Nasal endoscopy is a cornerstone in diagnosing sinonasal disease, but different raters might generate different results using the technique. Our study aims to evaluate the agreement between multiple raters to assess the validity of nasal endoscopy. Design/Participants: Three independent and blinded raters evaluated 28 patients (56 nasal cavities) diagnosed with chronic rhinosinusitis according to the European Position Paper on Rhinosinusitis and Nasal Polyps. The ratings were compared using unweighted Fleiss' kappa coefficients (Kf) for each objective parameter. Setting: The department of Otorhinolaryngology, Odense University Hospital, Denmark. Main outcome measures: The ratings were quantified in a modified Lund-Kennedy endoscopy score and focused on the objective parameters specified in the diagnostic criteria: polyps, oedema and discharge. Results: The raters agreed on the findings concerning polyps and discharge but not regarding oedema with the inter-rater agreement for the different parameters being: polyps Kf=.66 (SE .07, P<.001), oedema Kf=.05 (SE .07, P=.21), discharge Kf=.35 (SE .08, P<.001), oedema exclusively in middle meatus Kf=-.07 (SE .04, P=.8) and discharge exclusively in middle meatus Kf=.16 (SE .07, P=.01). Conclusion: Using nasal endoscopy, the evaluation of polyps by multiple raters showed sufficient reliability indicating an acceptable objective evaluation. The evaluation of discharge achieved a fair level of agreement while the assessment of oedema could not achieve a sufficient reliability questioning the inclusion of oedema in the criteria for diagnosing sinonasal disease.

Original languageEnglish
JournalClinical Otolaryngology
Volume43
Issue number1
Pages (from-to)144–150
ISSN1749-4478
DOIs
Publication statusPublished - Feb 2018

Fingerprint

Nose
Nasal Polyps
Nasal Cavity
Denmark
Outcome Assessment (Health Care)

Keywords

  • Agreement
  • Chronic rhinosinusitis
  • Inter-rater
  • Nasal endoscopy
  • Diagnosis, Differential
  • Reproducibility of Results
  • Endoscopy/methods
  • Humans
  • Middle Aged
  • Male
  • Rhinitis/diagnosis
  • Incidence
  • Denmark/epidemiology
  • Nose
  • Adult
  • Female
  • ROC Curve
  • Aged
  • Chronic Disease
  • Sinusitis/diagnosis

Cite this

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title = "The validity of nasal endoscopy in patients with chronic rhinosinusitis: An inter-rater agreement study",
abstract = "Objectives: Nasal endoscopy is a cornerstone in diagnosing sinonasal disease, but different raters might generate different results using the technique. Our study aims to evaluate the agreement between multiple raters to assess the validity of nasal endoscopy. Design/Participants: Three independent and blinded raters evaluated 28 patients (56 nasal cavities) diagnosed with chronic rhinosinusitis according to the European Position Paper on Rhinosinusitis and Nasal Polyps. The ratings were compared using unweighted Fleiss' kappa coefficients (Kf) for each objective parameter. Setting: The department of Otorhinolaryngology, Odense University Hospital, Denmark. Main outcome measures: The ratings were quantified in a modified Lund-Kennedy endoscopy score and focused on the objective parameters specified in the diagnostic criteria: polyps, oedema and discharge. Results: The raters agreed on the findings concerning polyps and discharge but not regarding oedema with the inter-rater agreement for the different parameters being: polyps Kf=.66 (SE .07, P<.001), oedema Kf=.05 (SE .07, P=.21), discharge Kf=.35 (SE .08, P<.001), oedema exclusively in middle meatus Kf=-.07 (SE .04, P=.8) and discharge exclusively in middle meatus Kf=.16 (SE .07, P=.01). Conclusion: Using nasal endoscopy, the evaluation of polyps by multiple raters showed sufficient reliability indicating an acceptable objective evaluation. The evaluation of discharge achieved a fair level of agreement while the assessment of oedema could not achieve a sufficient reliability questioning the inclusion of oedema in the criteria for diagnosing sinonasal disease.",
keywords = "Agreement, Chronic rhinosinusitis, Inter-rater, Nasal endoscopy, Diagnosis, Differential, Reproducibility of Results, Endoscopy/methods, Humans, Middle Aged, Male, Rhinitis/diagnosis, Incidence, Denmark/epidemiology, Nose, Adult, Female, ROC Curve, Aged, Chronic Disease, Sinusitis/diagnosis",
author = "Larsen, {K. L.} and B. Lange and P. Darling and G. J{\o}rgensen and Kjeldsen, {A. D.}",
year = "2018",
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language = "English",
volume = "43",
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journal = "Clinical Otolaryngology",
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The validity of nasal endoscopy in patients with chronic rhinosinusitis : An inter-rater agreement study. / Larsen, K. L.; Lange, B.; Darling, P.; Jørgensen, G.; Kjeldsen, A. D.

In: Clinical Otolaryngology, Vol. 43, No. 1, 02.2018, p. 144–150.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - The validity of nasal endoscopy in patients with chronic rhinosinusitis

T2 - An inter-rater agreement study

AU - Larsen, K. L.

AU - Lange, B.

AU - Darling, P.

AU - Jørgensen, G.

AU - Kjeldsen, A. D.

PY - 2018/2

Y1 - 2018/2

N2 - Objectives: Nasal endoscopy is a cornerstone in diagnosing sinonasal disease, but different raters might generate different results using the technique. Our study aims to evaluate the agreement between multiple raters to assess the validity of nasal endoscopy. Design/Participants: Three independent and blinded raters evaluated 28 patients (56 nasal cavities) diagnosed with chronic rhinosinusitis according to the European Position Paper on Rhinosinusitis and Nasal Polyps. The ratings were compared using unweighted Fleiss' kappa coefficients (Kf) for each objective parameter. Setting: The department of Otorhinolaryngology, Odense University Hospital, Denmark. Main outcome measures: The ratings were quantified in a modified Lund-Kennedy endoscopy score and focused on the objective parameters specified in the diagnostic criteria: polyps, oedema and discharge. Results: The raters agreed on the findings concerning polyps and discharge but not regarding oedema with the inter-rater agreement for the different parameters being: polyps Kf=.66 (SE .07, P<.001), oedema Kf=.05 (SE .07, P=.21), discharge Kf=.35 (SE .08, P<.001), oedema exclusively in middle meatus Kf=-.07 (SE .04, P=.8) and discharge exclusively in middle meatus Kf=.16 (SE .07, P=.01). Conclusion: Using nasal endoscopy, the evaluation of polyps by multiple raters showed sufficient reliability indicating an acceptable objective evaluation. The evaluation of discharge achieved a fair level of agreement while the assessment of oedema could not achieve a sufficient reliability questioning the inclusion of oedema in the criteria for diagnosing sinonasal disease.

AB - Objectives: Nasal endoscopy is a cornerstone in diagnosing sinonasal disease, but different raters might generate different results using the technique. Our study aims to evaluate the agreement between multiple raters to assess the validity of nasal endoscopy. Design/Participants: Three independent and blinded raters evaluated 28 patients (56 nasal cavities) diagnosed with chronic rhinosinusitis according to the European Position Paper on Rhinosinusitis and Nasal Polyps. The ratings were compared using unweighted Fleiss' kappa coefficients (Kf) for each objective parameter. Setting: The department of Otorhinolaryngology, Odense University Hospital, Denmark. Main outcome measures: The ratings were quantified in a modified Lund-Kennedy endoscopy score and focused on the objective parameters specified in the diagnostic criteria: polyps, oedema and discharge. Results: The raters agreed on the findings concerning polyps and discharge but not regarding oedema with the inter-rater agreement for the different parameters being: polyps Kf=.66 (SE .07, P<.001), oedema Kf=.05 (SE .07, P=.21), discharge Kf=.35 (SE .08, P<.001), oedema exclusively in middle meatus Kf=-.07 (SE .04, P=.8) and discharge exclusively in middle meatus Kf=.16 (SE .07, P=.01). Conclusion: Using nasal endoscopy, the evaluation of polyps by multiple raters showed sufficient reliability indicating an acceptable objective evaluation. The evaluation of discharge achieved a fair level of agreement while the assessment of oedema could not achieve a sufficient reliability questioning the inclusion of oedema in the criteria for diagnosing sinonasal disease.

KW - Agreement

KW - Chronic rhinosinusitis

KW - Inter-rater

KW - Nasal endoscopy

KW - Diagnosis, Differential

KW - Reproducibility of Results

KW - Endoscopy/methods

KW - Humans

KW - Middle Aged

KW - Male

KW - Rhinitis/diagnosis

KW - Incidence

KW - Denmark/epidemiology

KW - Nose

KW - Adult

KW - Female

KW - ROC Curve

KW - Aged

KW - Chronic Disease

KW - Sinusitis/diagnosis

U2 - 10.1111/coa.12916

DO - 10.1111/coa.12916

M3 - Journal article

VL - 43

SP - 144

EP - 150

JO - Clinical Otolaryngology

JF - Clinical Otolaryngology

SN - 1749-4478

IS - 1

ER -