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Interrater Reliability for Classifying Craniofacial Microsomia Severity: A Call for Objective Evaluation.

Elsa M Ronde1,2,3,4, Jitske W Nolte2,4, Alfred G Becking2,3,4

  • 1Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|November 23, 2023
PubMed
Summary

The Phenotypic Assessment Tool for Craniofacial Microsomia (PAT-CFM) shows high reliability for classifying ear and mandible severity in craniofacial microsomia (CFM). However, orbit, nerve, and soft tissue assessments may be less reliable.

Keywords:
OMENSPAT-CFM‌facial morphologyhemifacial microsomiaimagingreliability‌severity classification

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Area of Science:

  • Medical Imaging
  • Plastic Surgery
  • Genetics

Background:

  • Craniofacial microsomia (CFM) severity is typically assessed using the Orbit, Mandible, Ear, Soft tissue, Nerve (OMENS) score.
  • The Phenotypic Assessment Tool for Craniofacial Microsomia (PAT-CFM) offers a pictorial modification of the OMENS classification for global assessment.

Purpose of the Study:

  • To evaluate the interrater reliability of the PAT-CFM global assessment score for craniofacial microsomia.

Main Methods:

  • A prospective cohort study involving three clinicians assessing PAT-CFM global forms.
  • Mandible classification utilized orthopantomogram and/or computed tomography imaging.
  • Interrater agreement was quantified using weighted Krippendorff alpha (α) with 95% confidence intervals (CI).

Main Results:

  • The study included 53 patients (106 hemifaces).
  • High reliability was observed for mandible (α = 0.904) and ear (α = 0.958) subscales.
  • Tentative reliability was found for orbit (α = 0.682) and nerve (α = 0.782) subscales.

Conclusions:

  • The ear and radiographic mandible scales of the PAT-CFM demonstrate high interrater reliability.
  • The orbit, facial nerve, and soft tissue subscales may have limited reliability.
  • Further research is needed for objective, non-ionizing imaging methods for early classification of orbital and soft tissue hypoplasia.