Reliability of the reflux finding score for infants in flexible versus rigid laryngoscopy. (July 2016)

• Record Type: Journal Article
• Authors: Singendonk, Maartje M.J.; Pullens, Bas; van Heteren, Jan A.A.; de Gier, Henriëtte H.W.; Hoeve, Hans L.J.; König, Astrid M.; van der Schroeff, Marc P.; Hoekstra, Carlijn E.L.; Veder, Laura L.; van der Pol, Rachel J.; Benninga, Marc A.; van Wijk, Michiel P.
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 86(2016:Jul.)
• Page Start: 37
• Page End: 42
• Publication Date: 2016-07
• Subjects: LPR -- Laryngopharyngeal reflux -- Diagnostic; ALTE apparent life threatening event -- CI confidence interval -- GER gastro-esophageal reflux -- ICC intraclass correlation coefficient -- LPR laryngopharyngeal reflux -- NS not significant -- pH-MII pH-impedance monitoring -- PPI proton pump inhibitor -- RFS reflux finding score -- RFS-I reflux finding score for infants; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2016.04.017
• Languages: English
• ISSNs: 0165-5876

Abstract

Abstract: Objectives: The Reflux Finding Score for Infants (RFS-I) was developed to assess signs of laryngopharyngeal reflux (LPR) in infants. With flexible laryngoscopy, moderate inter- and highly variable intraobserver reliability was found. We hypothesized that the use of rigid laryngoscopy would increase reliability and therefore evaluated the reliability of the RFS-I for flexible versus rigid laryngoscopy in infants. Methods: We established a set of videos of consecutively performed flexible and rigid laryngoscopies in infants. The RFS-I was scored twice by 4 otorhinolaryngologists, 2 otorhinolaryngology fellows, and 2 inexperienced observers. Cohen's and Fleiss' kappas ( k ) were calculated for categorical data and the intraclass correlation coefficient (ICC) was calculated for ordinal data. Results: The study set consisted of laryngoscopic videos of 30 infants (median age 7.5 (0–19.8) months). Overall interobserver reliability of the RFS-I was moderate for both flexible (ICC = 0.60, 95% CI 0.44–0.76) and rigid (ICC = 0.42, 95% CI 0.26–0.62) laryngoscopy. There were no significant differences in reliability of overall RFS-I scores and individual RFS-I items for flexible versus rigid laryngoscopy. Intraobserver reliability of the total RFS-I score ranged from fair to excellent for both flexible (ICC = 0.33–0.93) and rigid (ICC = 0.39–0.86) laryngoscopies. Comparing RFS-I results for flexible versus rigid laryngoscopy per observer, reliability ranged from no to substantial ( k = −0.16–0.63, mean k = 0.22), with an observed agreement of 0.08–0.35. Conclusion: Reliability of the RFS-I was moderate and did not differ between flexible and rigid laryngoscopies. The RFS-I is not suitable to detect signs or to guide treatment of LPR in infants, neither with flexible nor with rigid laryngoscopy.