Development and validation of the international pediatric sleep endoscopy scale (IPSES)

Derek J Lam; Norman R Friedman; Kate C Chan; Erin M Kirkham; David F Smith; Palma Benedek; An Boudewyns

doi:10.1016/j.ijporl.2023.111748

Development and validation of the international pediatric sleep endoscopy scale (IPSES)

Int J Pediatr Otorhinolaryngol. 2023 Nov:174:111748. doi: 10.1016/j.ijporl.2023.111748. Epub 2023 Oct 6.

Authors

Derek J Lam¹, Norman R Friedman², Kate C Chan³, Erin M Kirkham⁴, David F Smith⁵, Palma Benedek⁶, An Boudewyns⁷

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, 97239, USA. Electronic address: lamde@ohsu.edu.
² Pediatric Otolaryngology, Children's Hospital of Colorado (CHCO), Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Anschutz Medical Campus, USA.
³ Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA.
⁶ Division of Sleep Laboratory and Sleep Surgery, Heim Pal National Pediatric Institute, Budapest, Hungary.
⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium.

PMID: 37820572
DOI: 10.1016/j.ijporl.2023.111748

Abstract

Objectives: To develop and validate a consensus international pediatric sleep endoscopy scale (IPSES) for pediatric drug-induced sleep endoscopy (DISE).

Methods: Existing published DISE ratings scales were reviewed in order to develop a consensus rating scale synthesizing the most common features and adding new elements to address areas of controversy. Samples of 30 de-identified DISE video recordings were reviewed to develop and refine the scale. After the consensus scale was defined, a separate sample of 25 de-identified DISE videos were scored with the new consensus scale by the development group and a panel of independent raters. A weighted kappa statistic was used to quantify the inter-rater and intra-rater reliability of the consensus scale at each anatomic level.

Results: Among all raters, intra-rater reliability was most variable for the nasal airway (kappa range 0.33-0.94) and best for the lateral oropharynx (kappa range 0.68-0.95). Inter-rater reliability ranged from 0.43 for the nasal airway to 0.57 at the soft palate.

Conclusion: The IPSES is a reliable consensus scale that reflects the most common features of existing scales and can be adopted as a universal scoring scale for pediatric DISE.

Keywords: Consensus; DISE; Pediatric; Reliability; Sleep apnea; Sleep endoscopy; Validation.

MeSH terms

Child
Endoscopy
Humans
Palate, Soft
Reproducibility of Results
Sleep
Sleep Apnea, Obstructive*