title: A grading scale for pediatric vocal fold nodules.
abstract: OBJECTIVE
  To design a grading scale for vocal fold nodules in pediatric patients.
  
  
  METHODS
  We conducted a prospective study in which a grading scale for vocal nodule size and contour based on static fiberoptic images of pediatric larynges was developed to achieve the scale presented here.
  
  
  RESULTS
  Twenty-eight health care professionals each rated 28 images of pediatric vocal fold nodules. The intraclass correlation for nodule size was strong (0.77; 95% confidence interval, 0.67-0.87). The kappa statistic for nodule contour was mild (0.35; 95% confidence interval, 0.33-0.37). Agreement between experienced and other raters found no significant difference for the nodule size or contour grade of a given image.
  
  
  CONCLUSIONS
  A grading scale for pediatric vocal fold nodules is presented. Interrater reliability for nodule size is high and can be reliably used by health care professionals with varying levels of experience.
  
  
  CONCLUSIONS
  A validated grading scale facilitates objective analysis of outcomes when studying and following patients with vocal nodules.
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, Washington, DC 20010, and Clinical Research Program, Children's Hospital Boston and Harvard Medical School, MA, USA. banuandrahul@aol.com
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Roger C
authors.initials: RC
authors.lastname: Nuss
mesh_terms: D002648:Child; D005336:Fiber Optic Technology; D006801:Humans; D007818:Laryngeal Diseases / Q000145:classification* / Q000175:diagnosis; D011446:Prospective Studies; D011897:Random Allocation; D049489:Stroboscopy; D014741:Video Recording; D014827:Vocal Cords