Diagnostic accuracy of current glossoptosis classification systems: A nested cohort cross-sectional study

Area of Science:

• Pediatric Otolaryngology
• Sleep Medicine
• Medical Diagnostics

Background:

• Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction.
• Glossoptosis, the posterior displacement of the tongue, is a key feature of RS and can lead to severe respiratory distress.
• Accurate assessment of glossoptosis severity is crucial for timely and effective clinical management.

Purpose of the Study:

• To evaluate the performance of two endoscopic grading systems, Yellon (Y) and de Sousa (S), in identifying severe clinical manifestations in children with Robin sequence.
• To compare the sensitivity and specificity of the Yellon and de Sousa scales against a clinical severity classification (Cole et al.).

Main Methods:

• A nested cohort cross-sectional study was conducted with 80 patients diagnosed with Robin sequence.
• Patients underwent sleep endoscopy and were graded using the Yellon (Y) and de Sousa (S) scales.
• Clinical severity was assessed using the Cole et al. classification, with Grade 3 considered severe.

Main Results:

• Both Yellon and de Sousa systems demonstrated low sensitivity (Y: 56.2%, S: 28.1%) but moderate to high specificity (Y: 85.4%, S: 93.8%) in identifying severe clinical manifestations (Cole grade 3).
• A low but significant correlation was found between both grading systems and the Cole classification (Y: rho=0.372, S: rho=0.439).
• Diagnostic odds ratios and areas under the receiver operating characteristic curves were not significantly different between the Yellon and de Sousa systems.

Conclusions:

• The Yellon and de Sousa endoscopic grading systems for glossoptosis in Robin sequence exhibit limited sensitivity in detecting severe clinical manifestations.
• While these systems show moderate to high specificity, their low sensitivity indicates a need for improved diagnostic tools.
• Further development of more discriminative anatomic grading systems is essential for accurately assessing glossoptosis severity in Robin sequence patients.