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Agreement of Clinician-Administered and Modified Parent-Administered House-Brackmann Scales in Children with Bell's
Franz E Babl1,2,3,4, Nitaa Eapen1,2,3, David Herd5,6,7
1Emergency Department Royal Children's Hospital Parkville Victoria Australia.
Insights
A new parent-administered scale for facial nerve function in children with Bell's palsy shows good agreement with the clinician-administered House-Brackmann (HB) scale. This tool can help monitor pediatric facial paralysis recovery at home.
Area of Science:
- Pediatric neurology
- Clinical assessment tools
- Facial nerve function evaluation
Background:
- No validated parent-administered scale exists for assessing facial nerve function in children.
- Bell's palsy, a common cause of childhood facial paralysis, requires reliable functional assessment.
- Existing clinician-administered scales may not capture the full spectrum of recovery from a parent's perspective.
Purpose of the Study:
- To evaluate the agreement between a novel parent-administered modified House-Brackmann (HB) scale and the standard clinician-administered HB scale.
- To determine the reliability of parent-reported facial nerve function in pediatric Bell's palsy patients.
- To establish a practical tool for at-home monitoring of facial paralysis recovery in children.
Main Methods:
- Secondary analysis of a randomized, placebo-controlled trial involving children (6 months to <18 years) with Bell's palsy.
- Children were assessed using both clinician- and parent-administered modified HB scales at baseline, 1, 3, and 6 months post-symptom onset.
- Agreement was quantified using intraclass correlation coefficients (ICC) and Bland-Altman plots.
Main Results:
- The mean ICC between clinician and parent HB scores across all time points was 0.88, indicating good agreement.
- ICC values at individual time points ranged from 0.53 (baseline) to 0.88 (1 month).
- Bland-Altman analysis showed a minimal mean difference (-0.07) between clinician and parent scores, with narrow limits of agreement.
Conclusions:
- A modified parent-administered HB scale demonstrates good agreement with the clinician-administered scale for assessing facial nerve function in children with Bell's palsy.
- This parent-reported scale offers a reliable method for monitoring recovery and can be a valuable adjunct to clinical evaluations.
- The findings support the use of this scale for improving home-based assessment and management of pediatric facial paralysis.
Objective:
Currently there is no parent administered scale for facial nerve function in children. We set out to assess the agreement between a newly developed parent-administered modified version of the House-Brackmann (HB) scale and the standard clinician-administered HB scale in children with Bell's palsy.
Study Design:
Secondary analysis of a triple-blind, randomized, placebo-controlled trial of corticosteroids to treat idiopathic facial paralysis (Bell's palsy) in children (6 months to <18 years).
Setting:
Multicenter study at pediatric hospitals with recruitment in emergency departments.
Methods:
Children were recruited within 72 hours of symptom onset and assessed using the clinician-administered and the parent-administered modified HB scales at baseline, and at 1, 3, and 6 months until recovered. Agreement between the 2 scales was assessed using intraclass coefficient (ICC) and a Bland-Altman plot.
Results:
Data were available for 174 of the 187 children randomized from at least 1 study time point. The mean ICC between clinician and parent HB scores across all time points was 0.88 (95% confidence interval, CI: 0.86, 0.90). The ICC for the data collected at baseline was 0.53 (95% CI: 0.43, 0.64), at 1 month was 0.88 (95% CI: 0.84, 0.91), at 3 months was 0.80 (95% CI: 0.71, 0.87) and at 6 months was 0.73 (95% CI: 0.47, 0.89). A Bland-Altman plot indicated a mean difference between the 2 scores (clinician-reported minus parent-reported) of only -0.07 (95% limits of agreement -1.37 to 1.23).
Conclusion:
There was good agreement between the modified parent-administered and the clinician-administered HB scales.
