title: A step backward: the 'Rough' facial nerve grading system.
abstract: OBJECTIVE
  Several modalities currently exist to rate the degree of facial function clinically but even though it has significant limitations, the most widely used scale is the House-Brackmann grading system (HBGS). A simplified scale is introduced here, the 'Rough' Grading System (RGS - Grade I: normal movement; Grade II: slight paralysis; Grade III: frank paralysis with eye closure; Grade IV: frank paralysis without eye closure; Grade V: almost complete paralysis with only slight movements; Grade VI: total paralysis). The aim of the present study was to verify the interrater reliability and the interscale validity of this simplified grading system.
  
  
  METHODS
  Scale validation study based on a prospective cohort.
  
  
  METHODS
  Fifty patients with facial palsy, consecutively referred to our department were filmed while performing some codified facial movements. Then two independent groups (one rating using the HBGS, the other rating using the RGS) assigned a grade after reviewing the videos. The time required for the rating was also noted.
  
  
  RESULTS
  The HBGS showed a mean value of interrater agreement of 0.46 while the RGS showed a mean value of 0.59. The concurrent validity between HBGS and RGS ranged from 0.86 to 0.90 (p < 0.001 for every comparison). There was no statistically significant difference between HBGS and RGS in the mean time taken for rating (p = 0.15).
  
  
  CONCLUSIONS
  The RGS reached an adequate level of interrater reliability, higher than the HBGS. The correlation between the two scales is high and the times required for rating are similar. The present results may justify the use of the RGS in routine clinical practice.
  
  
  METHODS
  N/A.
authors: Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy.
authors: Matteo
authors: M
authors: Alicandri-Ciufelli
authors: Alessia
authors: A
authors: Piccinini
authors: Alberto
authors: A
authors: Grammatica
authors: Francesca
authors: F
authors: Salafia
authors: Cristel
authors: C
authors: Ciancimino
authors: Eliomaria
authors: E
authors: Cunsolo
authors: Luca
authors: L
authors: Pingani
authors: Marco
authors: M
authors: Rigatelli
authors: Elisabetta
authors: E
authors: Genovese
authors: Daniele
authors: D
authors: Monzani
authors: Federico Maria
authors: FM
authors: Gioacchini
authors: Daniele
authors: D
authors: Marchioni
authors: Livio
authors: L
authors: Presutti
mesh_terms: D001767:Blinking / Q000502:physiology; D005133:Eye Movements / Q000502:physiology; D005143:Eyelids / Q000503:physiopathology; D005146:Facial Asymmetry / Q000145:classification / Q000503:physiopathology; D005149:Facial Expression; D005152:Facial Muscles / Q000503:physiopathology; D005158:Facial Paralysis / Q000145:classification* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000145:classification; D015588:Observer Variation; D015203:Reproducibility of Results; D012904:Smiling / Q000502:physiology
keywords: Facial nerve grading system; Facial palsy; House–Brackmann grading system; Interrater reliability; Subjective scale