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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Assessment of adenoidal obstruction in children: clinical signs versus roentgenographic findings.
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Assessment of adenoidal obstruction in children: clinical signs versus roentgenographic findings.

机译：儿童腺样体梗阻的评估：临床体征与X线摄片结果。

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OBJECTIVE: As part of a comprehensive study of indications for tonsillectomy and adenoidectomy, we investigated the reliability of standardized clinical assessments and standardized roentgenographic assessments of adenoidal obstruction of the nasopharynx, and the degree of correlation between clinical assessments and roentgenographic assessments. METHODS: We rated the degree of patients' mouth breathing and patients' speech hyponasality on a 4-point scale (none = 1; mild = 2; moderate = 3; marked = 4), we averaged the ratings for each child to obtain a Nasal Obstruction Index, and we determined levels of interobserver agreement concerning the ratings. We classified lateral soft-tissue roentgenograms of the nasopharynx, based on assessments of adenoid size and of nasopharyngeal airway patency, as showing either no obstruction, borderline obstruction, or obstruction, and we determined levels of inter- and intraobserver agreement concerning the classifications. Finally, we determined correlations in individual patients between clinical ratings and roentgenographic ratings of nasalasopharyngeal obstruction, and calculated the predictive values of clinical ratings based on roentgenographic ratings as the gold standard. RESULTS: In sets of paired examinations, weighted kappa values for interobserver agreement concerning mouth breathing (total, 235 children) and speech hyponasality (total, 648 children) ranged from 0.84 to 0.91. The value for interobserver agreement concerning roentgenographic assessment of nasopharyngeal airway status (207 children) was 0.92, and for intraobserver agreement (191 children) 0.88. The Kendall's tau b value for concordance between Nasal Obstruction Index values and roentgenographic ratings (1033 children) was 0.51. Nasal Obstruction Index values at the lower and upper extremes--i.e., 1.0 and > or = 3.5, respectively--were highly predictive of concordant roentgenographic ratings. CONCLUSIONS: We conclude that standardized clinical ratings of the degree of children's mouth breathing and speech hyponasality provide reliable and reasonably valid assessments of the presence and degree of adenoidal obstruction of the nasopharyngeal airway. These clinical assessments are particularly valid at the extremes of either marked obstruction or no obstruction. Clinical assessment alone may be insufficient to establish the presence of adenoidal obstruction, but clinical assessment alone when findings are unequivocally negative can suffice to rule out adenoidal obstruction with a high degree of confidence.
机译：目的：作为扁桃体切除术和腺样体切除术适应症综合研究的一部分，我们调查了鼻咽腺样阻塞的标准化临床评估和标准化X线摄片评估的可靠性，以及临床评估与X线摄片评估之间的相关程度。方法：我们以4分制（无= 1;轻度= 2;中度= 3;标记= 4）对患者的口呼吸程度和患者的言语低下程度进行评分，我们对每个孩子的评分进行平均以获得一个鼻阻塞指数，我们确定了有关评级的观察者间共识水平。我们根据对腺样体大小和鼻咽气道通畅性的评估，将鼻咽的侧部软组织X线体层照相图分类为没有阻塞，边界阻塞或阻塞，并确定了观察者之间和内部关于分类的一致性水平。最后，我们确定了各个患者的临床评分与鼻腔/鼻咽阻塞的X线照片评分之间的相关性，并基于X线照片的评分作为金标准，计算了临床评分的预测值。结果：在成对的检查中，观察者之间关于口呼吸（总计235名儿童）和言语低下症（总计648名儿童）的一致性的加权kappa值介于0.84至0.91之间。进行鼻腔造影检查鼻咽气道状况的观察者间协议的价值（0.97名儿童）为0.92，观察者内协议（191例儿童）的价值为0.88。 Kendall的tau b值（鼻阻塞指数值与X线摄片定级之间的一致性）为0.51。鼻塞指数值的下限和上限（分别为1.0和>或= 3.5）可以很好地预测一致的X线照片。结论：我们得出结论，儿童口呼吸和言语低下性程度的标准化临床评分为鼻咽气道腺样体阻塞的存在和程度提供了可靠和合理有效的评估。这些临床评估在明显阻塞或无阻塞的极端情况下特别有效。单靠临床评估可能不足以确定是否存在腺样体阻塞，但是当发现结果明确为阴性时，仅凭临床评估就可以高度肯定地排除腺样体阻塞。

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