Austin S Lam1,2, Michael D Bindschadler3,4, Kelly N Evans5,6, Seth D Friedman3,4, Matthew S Blessing5,6, Randall Bly1,2,6, Michael L Cunningham5,6, Mark A Egbert6,7,8, Russell E Ettinger6,9,10, Emily R Gallagher5,6, Richard A Hopper6,9,10, Kaalan Johnson1,2,6, Jonathan A Perkins1,2,6, Erin K Romberg3,4, Kathleen C Y Sie1,2,6, Srinivas M Susarla6,7,9,10, Carlton J Zdanski11, Xing Wang12, Jeffrey P Otjen3,4, Francisco A Perez3,4, John P Dahl1,2,6. 1. Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA. 2. Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA. 3. Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA. 4. Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA. 5. Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA. 6. Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA. 7. Division of Oral and Maxillofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA. 8. Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington, USA. 9. Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, USA. 10. Department of Surgery, University of Washington, Seattle, Washington, USA. 11. Department of Otolaryngology/Head & Neck Surgery and Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA. 12. Biostatistics, Epidemiology and Analytics in Research (BEAR) Core, Seattle Children's Research Institute, Seattle, Washington, USA.
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.
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.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Gadi Fishman; Meir Zemel; Ari DeRowe; Efraim Sadot; Yakov Sivan; Peter J Koltai Journal: Int J Pediatr Otorhinolaryngol Date: 2013-02-22 Impact factor: 1.675
Authors: A Giudice; S Barone; K Belhous; A Morice; V Soupre; F Bennardo; N Boddaert; M-P Vazquez; V Abadie; A Picard Journal: J Stomatol Oral Maxillofac Surg Date: 2018-05-17 Impact factor: 1.569
Authors: Craig Miller; Randall Bly; Shelagh Cofer; John P Dahl; Lianne de Serres; Steven Goudy; Larry Hartzell; Noel Jabbour; Deborah Kacmarysnki; Carol Macarthur; Anna Messner; Henry Milczuk; Jeff Rastatter; Laura H Swibel Rosenthal; Andrew Scott; Travis Tollefson; Audie Woolley; Carlton Zdanski; Dave A Zopf; Kathleen Sie Journal: Otolaryngol Head Neck Surg Date: 2019-01-15 Impact factor: 3.497
Authors: Corstiaan C Breugem; Kelly N Evans; Christian F Poets; Sunjay Suri; Arnaud Picard; Charles Filip; Emma C Paes; Felicity V Mehendale; Howard M Saal; Hanneke Basart; Jyotsna Murthy; Koen F M Joosten; Lucienne Speleman; Marcus V M Collares; Marie-José H van den Boogaard; Marvick Muradin; Maud Els-Marie Andersson; Mikihiko Kogo; Peter G Farlie; Peter Don Griot; Peter A Mossey; Rona Slator; Veronique Abadie; Paul Hong Journal: JAMA Pediatr Date: 2016-09-01 Impact factor: 16.193
Authors: Pierre Fayoux; Sam J Daniel; Gregory Allen; Karthik Balakrishnan; An Boudewyns; Alan Cheng; Alessandro De Alarcon; Dimple Goel; Catherine K Hart; Nicolas Leboulanger; Gi Lee; Eric Moreddu; Harlan Muntz; Reza Rahbar; Richard Nicollas; Carolyn R Rogers-Vizena; John Russell; Michael J Rutter; Richard J H Smith; Michelle Wyatt; George Zalzal; Cory M Resnick Journal: Int J Pediatr Otorhinolaryngol Date: 2019-12-28 Impact factor: 1.675
Authors: Michael Barbour; Clare Richardson; Mike Bindschadler; Seth Friedman; Randall Bly; John P Dahl; Alberto Aliseda Journal: Ann Biomed Eng Date: 2022-08-11 Impact factor: 4.219