Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence
Objectives To evaluate the performance of 4-dimensional computed tomography (4D-CT) in assessing upper airway obstruction (UAO) in patients with Robin sequence (RS) and compare the accuracy and reliability of 4D-CT and flexible fiber-optic laryngoscopy (FFL). Study Design Prospective survey of retro...
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| Veröffentlicht in: | Otolaryngology-head and neck surgery 2022-04, Vol.166 (4), p.760-767 |
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| creator | Lam, Austin S. Bindschadler, Michael D. Evans, Kelly N. Friedman, Seth D. Blessing, Matthew S. Bly, Randall Cunningham, Michael L. Egbert, Mark A. Ettinger, Russell E. Gallagher, Emily R. Hopper, Richard A. Johnson, Kaalan Perkins, Jonathan A. Romberg, Erin K. Sie, Kathleen C. Y. Susarla, Srinivas M. Zdanski, Carlton J. Wang, Xing Otjen, Jeffrey P. Perez, Francisco A. Dahl, John P. |
| description | Objectives
To evaluate the performance of 4-dimensional computed tomography (4D-CT) in assessing upper airway obstruction (UAO) in patients with Robin sequence (RS) and compare the accuracy and reliability of 4D-CT and flexible fiber-optic laryngoscopy (FFL).
Study Design
Prospective survey of retrospective clinical data.
Setting
Single, tertiary care pediatric hospital.
Methods
At initial and 30-day time points, a multidisciplinary group of 11 clinicians who treat RS rated UAO severity in 32 sets of 4D-CT visualizations and FFL videos (dynamic modalities) and static CT images. Raters assessed UAO at the velopharynx and oropharynx (1 = none to 5 = complete) and noted confidence levels of each rating. Intraclass correlation and Krippendorff alpha were used to assess intra- and interrater reliability, respectively. Accuracy was assessed by comparing clinician ratings with quantitative percentage constriction (QPC) ratings, calculated based on 4D-CT airway cross-sectional area. Results were compared using Wilcoxon rank-sum and signed-rank tests.
Results
There was similar intrarater agreement (moderate to substantial) with 4D-CT and FFL, and both demonstrated fair interrater agreement. Both modalities underestimated UAO severity, although 4D-CT ratings were significantly more accurate, as determined by QPC similarity, than FFL (−1.06 and −1.46 vs QPC ratings, P = .004). Overall confidence levels were similar for 4D-CT and FFL, but other specialists were significantly less confident in FFL ratings than were otolaryngologists (2.25 and 3.92, P < .0001).
Conclusion
Although 4D-CT may be more accurate in assessing the degree of UAO in patients with RS, 4D-CT and FFL assessments demonstrate similar reliability. Additionally, 4D-CT may be interpreted with greater confidence by nonotolaryngologists who care for these patients. |
| doi_str_mv | 10.1177/01945998211027353 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8755858</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_01945998211027353</sage_id><sourcerecordid>2551207028</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4886-1b565a05781dc601075359cd89841d1ccdd66fc825b42b05eeedfc3cf18f0b783</originalsourceid><addsrcrecordid>eNqFkU1v1DAYhC0EokvhB3BBPnJJ8ZvEXxekZem2SCsqlfZsOY6zdeW1g71pyb8n6ZYKhAQX-zDPjEcehN4COQHg_AMBWVMpRQlASl7R6hlaAJG8YAL4c7SY9WIGjtCrnG8JIYxx_hIdVXVJKwBYoJulMUPSZsQ6tPjSeqcb591-xLHD9edidfUgrL394Rpv8UanMWxjNrEfsQv4uu9twkuX7vWIT--0H_TexTBLl7GZzm_2-2CDsa_Ri077bN883sfoen16tTovNhdnX1bLTWFqIVgBDWVUE8oFtIYRIJxWVJpWSFFDC8a0LWOdESVt6rIh1FrbdqYyHYiONFxUx-jjIbcfmp1tjQ37pL3qk9tN1VXUTv2pBHejtvFOCU6poHPA-8eAFKfqea92LhvrvQ42DlmVlEJJOClnFA6oSTHnZLunZ4CoeSH110KT593v_Z4cvyaZAHkA7p234_8T1cX5109rIqlkk_fk4M16a9VtHFKY_vofbX4C-n-pxg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2551207028</pqid></control><display><type>article</type><title>Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>SAGE Complete</source><creator>Lam, Austin S. ; Bindschadler, Michael D. ; Evans, Kelly N. ; Friedman, Seth D. ; Blessing, Matthew S. ; Bly, Randall ; Cunningham, Michael L. ; Egbert, Mark A. ; Ettinger, Russell E. ; Gallagher, Emily R. ; Hopper, Richard A. ; Johnson, Kaalan ; Perkins, Jonathan A. ; Romberg, Erin K. ; Sie, Kathleen C. Y. ; Susarla, Srinivas M. ; Zdanski, Carlton J. ; Wang, Xing ; Otjen, Jeffrey P. ; Perez, Francisco A. ; Dahl, John P.</creator><creatorcontrib>Lam, Austin S. ; Bindschadler, Michael D. ; Evans, Kelly N. ; Friedman, Seth D. ; Blessing, Matthew S. ; Bly, Randall ; Cunningham, Michael L. ; Egbert, Mark A. ; Ettinger, Russell E. ; Gallagher, Emily R. ; Hopper, Richard A. ; Johnson, Kaalan ; Perkins, Jonathan A. ; Romberg, Erin K. ; Sie, Kathleen C. Y. ; Susarla, Srinivas M. ; Zdanski, Carlton J. ; Wang, Xing ; Otjen, Jeffrey P. ; Perez, Francisco A. ; Dahl, John P.</creatorcontrib><description>Objectives
To evaluate the performance of 4-dimensional computed tomography (4D-CT) in assessing upper airway obstruction (UAO) in patients with Robin sequence (RS) and compare the accuracy and reliability of 4D-CT and flexible fiber-optic laryngoscopy (FFL).
Study Design
Prospective survey of retrospective clinical data.
Setting
Single, tertiary care pediatric hospital.
Methods
At initial and 30-day time points, a multidisciplinary group of 11 clinicians who treat RS rated UAO severity in 32 sets of 4D-CT visualizations and FFL videos (dynamic modalities) and static CT images. Raters assessed UAO at the velopharynx and oropharynx (1 = none to 5 = complete) and noted confidence levels of each rating. Intraclass correlation and Krippendorff alpha were used to assess intra- and interrater reliability, respectively. Accuracy was assessed by comparing clinician ratings with quantitative percentage constriction (QPC) ratings, calculated based on 4D-CT airway cross-sectional area. Results were compared using Wilcoxon rank-sum and signed-rank tests.
Results
There was similar intrarater agreement (moderate to substantial) with 4D-CT and FFL, and both demonstrated fair interrater agreement. Both modalities underestimated UAO severity, although 4D-CT ratings were significantly more accurate, as determined by QPC similarity, than FFL (−1.06 and −1.46 vs QPC ratings, P = .004). Overall confidence levels were similar for 4D-CT and FFL, but other specialists were significantly less confident in FFL ratings than were otolaryngologists (2.25 and 3.92, P < .0001).
Conclusion
Although 4D-CT may be more accurate in assessing the degree of UAO in patients with RS, 4D-CT and FFL assessments demonstrate similar reliability. Additionally, 4D-CT may be interpreted with greater confidence by nonotolaryngologists who care for these patients.</description><identifier>ISSN: 0194-5998</identifier><identifier>EISSN: 1097-6817</identifier><identifier>DOI: 10.1177/01945998211027353</identifier><identifier>PMID: 34253111</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>4D‐CT ; Child ; computed tomography ; flexible fiber‐optic laryngoscopy ; Four-Dimensional Computed Tomography ; Humans ; Laryngoscopy - methods ; Pierre Robin Syndrome - diagnostic imaging ; Prospective Studies ; Reproducibility of Results ; Retrospective Studies ; Robin sequence ; upper airway obstruction</subject><ispartof>Otolaryngology-head and neck surgery, 2022-04, Vol.166 (4), p.760-767</ispartof><rights>American Academy of Otolaryngology–Head and Neck Surgery Foundation 2021</rights><rights>2022 American Association of Otolaryngology‐Head and Neck Surgery Foundation (AAO‐HNSF)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4886-1b565a05781dc601075359cd89841d1ccdd66fc825b42b05eeedfc3cf18f0b783</citedby><cites>FETCH-LOGICAL-c4886-1b565a05781dc601075359cd89841d1ccdd66fc825b42b05eeedfc3cf18f0b783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/01945998211027353$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/01945998211027353$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,21798,27901,27902,43597,43598,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34253111$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lam, Austin S.</creatorcontrib><creatorcontrib>Bindschadler, Michael D.</creatorcontrib><creatorcontrib>Evans, Kelly N.</creatorcontrib><creatorcontrib>Friedman, Seth D.</creatorcontrib><creatorcontrib>Blessing, Matthew S.</creatorcontrib><creatorcontrib>Bly, Randall</creatorcontrib><creatorcontrib>Cunningham, Michael L.</creatorcontrib><creatorcontrib>Egbert, Mark A.</creatorcontrib><creatorcontrib>Ettinger, Russell E.</creatorcontrib><creatorcontrib>Gallagher, Emily R.</creatorcontrib><creatorcontrib>Hopper, Richard A.</creatorcontrib><creatorcontrib>Johnson, Kaalan</creatorcontrib><creatorcontrib>Perkins, Jonathan A.</creatorcontrib><creatorcontrib>Romberg, Erin K.</creatorcontrib><creatorcontrib>Sie, Kathleen C. Y.</creatorcontrib><creatorcontrib>Susarla, Srinivas M.</creatorcontrib><creatorcontrib>Zdanski, Carlton J.</creatorcontrib><creatorcontrib>Wang, Xing</creatorcontrib><creatorcontrib>Otjen, Jeffrey P.</creatorcontrib><creatorcontrib>Perez, Francisco A.</creatorcontrib><creatorcontrib>Dahl, John P.</creatorcontrib><title>Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence</title><title>Otolaryngology-head and neck surgery</title><addtitle>Otolaryngol Head Neck Surg</addtitle><description>Objectives
To evaluate the performance of 4-dimensional computed tomography (4D-CT) in assessing upper airway obstruction (UAO) in patients with Robin sequence (RS) and compare the accuracy and reliability of 4D-CT and flexible fiber-optic laryngoscopy (FFL).
Study Design
Prospective survey of retrospective clinical data.
Setting
Single, tertiary care pediatric hospital.
Methods
At initial and 30-day time points, a multidisciplinary group of 11 clinicians who treat RS rated UAO severity in 32 sets of 4D-CT visualizations and FFL videos (dynamic modalities) and static CT images. Raters assessed UAO at the velopharynx and oropharynx (1 = none to 5 = complete) and noted confidence levels of each rating. Intraclass correlation and Krippendorff alpha were used to assess intra- and interrater reliability, respectively. Accuracy was assessed by comparing clinician ratings with quantitative percentage constriction (QPC) ratings, calculated based on 4D-CT airway cross-sectional area. Results were compared using Wilcoxon rank-sum and signed-rank tests.
Results
There was similar intrarater agreement (moderate to substantial) with 4D-CT and FFL, and both demonstrated fair interrater agreement. Both modalities underestimated UAO severity, although 4D-CT ratings were significantly more accurate, as determined by QPC similarity, than FFL (−1.06 and −1.46 vs QPC ratings, P = .004). Overall confidence levels were similar for 4D-CT and FFL, but other specialists were significantly less confident in FFL ratings than were otolaryngologists (2.25 and 3.92, P < .0001).
Conclusion
Although 4D-CT may be more accurate in assessing the degree of UAO in patients with RS, 4D-CT and FFL assessments demonstrate similar reliability. Additionally, 4D-CT may be interpreted with greater confidence by nonotolaryngologists who care for these patients.</description><subject>4D‐CT</subject><subject>Child</subject><subject>computed tomography</subject><subject>flexible fiber‐optic laryngoscopy</subject><subject>Four-Dimensional Computed Tomography</subject><subject>Humans</subject><subject>Laryngoscopy - methods</subject><subject>Pierre Robin Syndrome - diagnostic imaging</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Robin sequence</subject><subject>upper airway obstruction</subject><issn>0194-5998</issn><issn>1097-6817</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAYhC0EokvhB3BBPnJJ8ZvEXxekZem2SCsqlfZsOY6zdeW1g71pyb8n6ZYKhAQX-zDPjEcehN4COQHg_AMBWVMpRQlASl7R6hlaAJG8YAL4c7SY9WIGjtCrnG8JIYxx_hIdVXVJKwBYoJulMUPSZsQ6tPjSeqcb591-xLHD9edidfUgrL394Rpv8UanMWxjNrEfsQv4uu9twkuX7vWIT--0H_TexTBLl7GZzm_2-2CDsa_Ri077bN883sfoen16tTovNhdnX1bLTWFqIVgBDWVUE8oFtIYRIJxWVJpWSFFDC8a0LWOdESVt6rIh1FrbdqYyHYiONFxUx-jjIbcfmp1tjQ37pL3qk9tN1VXUTv2pBHejtvFOCU6poHPA-8eAFKfqea92LhvrvQ42DlmVlEJJOClnFA6oSTHnZLunZ4CoeSH110KT593v_Z4cvyaZAHkA7p234_8T1cX5109rIqlkk_fk4M16a9VtHFKY_vofbX4C-n-pxg</recordid><startdate>202204</startdate><enddate>202204</enddate><creator>Lam, Austin S.</creator><creator>Bindschadler, Michael D.</creator><creator>Evans, Kelly N.</creator><creator>Friedman, Seth D.</creator><creator>Blessing, Matthew S.</creator><creator>Bly, Randall</creator><creator>Cunningham, Michael L.</creator><creator>Egbert, Mark A.</creator><creator>Ettinger, Russell E.</creator><creator>Gallagher, Emily R.</creator><creator>Hopper, Richard A.</creator><creator>Johnson, Kaalan</creator><creator>Perkins, Jonathan A.</creator><creator>Romberg, Erin K.</creator><creator>Sie, Kathleen C. Y.</creator><creator>Susarla, Srinivas M.</creator><creator>Zdanski, Carlton J.</creator><creator>Wang, Xing</creator><creator>Otjen, Jeffrey P.</creator><creator>Perez, Francisco A.</creator><creator>Dahl, John P.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202204</creationdate><title>Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence</title><author>Lam, Austin S. ; Bindschadler, Michael D. ; Evans, Kelly N. ; Friedman, Seth D. ; Blessing, Matthew S. ; Bly, Randall ; Cunningham, Michael L. ; Egbert, Mark A. ; Ettinger, Russell E. ; Gallagher, Emily R. ; Hopper, Richard A. ; Johnson, Kaalan ; Perkins, Jonathan A. ; Romberg, Erin K. ; Sie, Kathleen C. Y. ; Susarla, Srinivas M. ; Zdanski, Carlton J. ; Wang, Xing ; Otjen, Jeffrey P. ; Perez, Francisco A. ; Dahl, John P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4886-1b565a05781dc601075359cd89841d1ccdd66fc825b42b05eeedfc3cf18f0b783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>4D‐CT</topic><topic>Child</topic><topic>computed tomography</topic><topic>flexible fiber‐optic laryngoscopy</topic><topic>Four-Dimensional Computed Tomography</topic><topic>Humans</topic><topic>Laryngoscopy - methods</topic><topic>Pierre Robin Syndrome - diagnostic imaging</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Robin sequence</topic><topic>upper airway obstruction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lam, Austin S.</creatorcontrib><creatorcontrib>Bindschadler, Michael D.</creatorcontrib><creatorcontrib>Evans, Kelly N.</creatorcontrib><creatorcontrib>Friedman, Seth D.</creatorcontrib><creatorcontrib>Blessing, Matthew S.</creatorcontrib><creatorcontrib>Bly, Randall</creatorcontrib><creatorcontrib>Cunningham, Michael L.</creatorcontrib><creatorcontrib>Egbert, Mark A.</creatorcontrib><creatorcontrib>Ettinger, Russell E.</creatorcontrib><creatorcontrib>Gallagher, Emily R.</creatorcontrib><creatorcontrib>Hopper, Richard A.</creatorcontrib><creatorcontrib>Johnson, Kaalan</creatorcontrib><creatorcontrib>Perkins, Jonathan A.</creatorcontrib><creatorcontrib>Romberg, Erin K.</creatorcontrib><creatorcontrib>Sie, Kathleen C. Y.</creatorcontrib><creatorcontrib>Susarla, Srinivas M.</creatorcontrib><creatorcontrib>Zdanski, Carlton J.</creatorcontrib><creatorcontrib>Wang, Xing</creatorcontrib><creatorcontrib>Otjen, Jeffrey P.</creatorcontrib><creatorcontrib>Perez, Francisco A.</creatorcontrib><creatorcontrib>Dahl, John P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Otolaryngology-head and neck surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lam, Austin S.</au><au>Bindschadler, Michael D.</au><au>Evans, Kelly N.</au><au>Friedman, Seth D.</au><au>Blessing, Matthew S.</au><au>Bly, Randall</au><au>Cunningham, Michael L.</au><au>Egbert, Mark A.</au><au>Ettinger, Russell E.</au><au>Gallagher, Emily R.</au><au>Hopper, Richard A.</au><au>Johnson, Kaalan</au><au>Perkins, Jonathan A.</au><au>Romberg, Erin K.</au><au>Sie, Kathleen C. Y.</au><au>Susarla, Srinivas M.</au><au>Zdanski, Carlton J.</au><au>Wang, Xing</au><au>Otjen, Jeffrey P.</au><au>Perez, Francisco A.</au><au>Dahl, John P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence</atitle><jtitle>Otolaryngology-head and neck surgery</jtitle><addtitle>Otolaryngol Head Neck Surg</addtitle><date>2022-04</date><risdate>2022</risdate><volume>166</volume><issue>4</issue><spage>760</spage><epage>767</epage><pages>760-767</pages><issn>0194-5998</issn><eissn>1097-6817</eissn><abstract>Objectives
To evaluate the performance of 4-dimensional computed tomography (4D-CT) in assessing upper airway obstruction (UAO) in patients with Robin sequence (RS) and compare the accuracy and reliability of 4D-CT and flexible fiber-optic laryngoscopy (FFL).
Study Design
Prospective survey of retrospective clinical data.
Setting
Single, tertiary care pediatric hospital.
Methods
At initial and 30-day time points, a multidisciplinary group of 11 clinicians who treat RS rated UAO severity in 32 sets of 4D-CT visualizations and FFL videos (dynamic modalities) and static CT images. Raters assessed UAO at the velopharynx and oropharynx (1 = none to 5 = complete) and noted confidence levels of each rating. Intraclass correlation and Krippendorff alpha were used to assess intra- and interrater reliability, respectively. Accuracy was assessed by comparing clinician ratings with quantitative percentage constriction (QPC) ratings, calculated based on 4D-CT airway cross-sectional area. Results were compared using Wilcoxon rank-sum and signed-rank tests.
Results
There was similar intrarater agreement (moderate to substantial) with 4D-CT and FFL, and both demonstrated fair interrater agreement. Both modalities underestimated UAO severity, although 4D-CT ratings were significantly more accurate, as determined by QPC similarity, than FFL (−1.06 and −1.46 vs QPC ratings, P = .004). Overall confidence levels were similar for 4D-CT and FFL, but other specialists were significantly less confident in FFL ratings than were otolaryngologists (2.25 and 3.92, P < .0001).
Conclusion
Although 4D-CT may be more accurate in assessing the degree of UAO in patients with RS, 4D-CT and FFL assessments demonstrate similar reliability. Additionally, 4D-CT may be interpreted with greater confidence by nonotolaryngologists who care for these patients.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>34253111</pmid><doi>10.1177/01945998211027353</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0194-5998 |
| ispartof | Otolaryngology-head and neck surgery, 2022-04, Vol.166 (4), p.760-767 |
| issn | 0194-5998 1097-6817 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8755858 |
| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; SAGE Complete |
| subjects | 4D‐CT Child computed tomography flexible fiber‐optic laryngoscopy Four-Dimensional Computed Tomography Humans Laryngoscopy - methods Pierre Robin Syndrome - diagnostic imaging Prospective Studies Reproducibility of Results Retrospective Studies Robin sequence upper airway obstruction |
| title | Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence |
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