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The reliability of clinical tonsil size grading in children
Divjot S Kumar1, Dianne Valenzuela1, Frederick K Kozak2
1Medical student at University of British Columbia, British Columbia, Canada.
Insights
The Brodsky tonsil grading scale demonstrated the highest reliability among clinicians for assessing tonsil size. This finding supports its adoption for consistent clinical and research documentation of tonsil enlargement.
Area of Science:
- Otolaryngology
- Pediatric Health
- Medical Diagnostics
Background:
- Tonsillar enlargement in children can lead to significant health issues, necessitating reliable methods for monitoring tonsil size.
- Existing tonsil grading scales aim to standardize size documentation but their clinical reliability remains unverified.
Purpose of the Study:
- To evaluate the interobserver and intraobserver reliability of the Brodsky and Friedman tonsil size grading scales.
- To assess the reliability of a novel 3-grade tonsil size scale in a clinical setting.
Main Methods:
- A cross-sectional study involving 116 children (aged 3-14) at a pediatric otolaryngology clinic.
- Four independent observers performed two separate tonsil assessments for each child using three different grading scales.
- Interobserver and intraobserver reliability were quantified using intraclass correlation coefficients (ICCs) and Pearson correlation coefficients.
Main Results:
- The Brodsky scale exhibited the highest mean interobserver reliability (ICC, 0.721), followed by the Friedman scale (ICC, 0.647) and the 3-grade scale (ICC, 0.599).
- Mean intraobserver reliabilities were high for all scales, with the Brodsky scale at 0.954, Friedman at 0.932, and the 3-grade scale at 0.927.
Conclusions:
- The Brodsky tonsil grading scale demonstrated superior interobserver and intraobserver reliability compared to the Friedman and the novel 3-grade scales.
- Results suggest the Brodsky scale is a reliable tool and recommend its standardized use in clinical practice and research for documenting tonsil size.
Importance:
Because tonsillar enlargement can have substantial ill health effects in children, reliable monitoring and documentation of tonsil size is necessary in clinical settings. Tonsil grading scales potentially allow clinicians to precisely record and communicate changes in tonsil size, but their reliability in a clinical setting has not been studied.
Objective:
To assess the interobserver and intraobserver reliability of the Brodsky and Friedman tonsil size grading scales and a novel 3-grade scale.
Design, Setting, And Participants:
Cross-sectional study between June 2012 and August 2013 at a tertiary pediatric otolaryngology outpatient clinic at British Columbia Children's Hospital. We recruited 116 children, aged 3 to 14 years, with no major craniofacial abnormalities. For each child, 2 separate tonsil assessments (with at least a 5-minute interval in between) were conducted by 4 independent observers: 2 staff pediatric otolaryngologists, 1 otolaryngology trainee (fellow or resident), and 1 medical student. Each observer assessed and graded tonsil sizes using 3 different scales.
Main Outcomes And Measures:
Interobserver and intraobserver reliabilities were assessed by deriving the intraclass correlation coefficients (ICCs) and Pearson correlation coefficients, respectively. To discount for any asymmetric scores, all data analysis was conducted on the left tonsil measurement only.
Results:
Mean interobserver reliability was highest for the Brodsky grading scale (ICC, 0.721; Cronbach α, 0.911), followed by the Friedman grading scale (ICC, 0.647; Cronbach α, 0.879) and the 3-grade scale (ICC, 0.599; Cronbach α, 0.857). The mean intraobserver reliabilities for the Brodsky, Friedman, and modified 3-grade scales were 0.954, 0.932, and 0.927, respectively.
Conclusions And Relevance:
The Brodsky grading scale offered the highest interobserver and intraobserver reliability when compared with the Friedman and novel 3-grade scales. The results of this study would support the uniform use of the Brodsky scale for future clinical and research work.
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