The interrater and intrarater reliability of the Philpott-Javer staging system based on level of training.
OBJECTIVE
The Philpott-Javer postoperative endoscopic mucosal staging system for allergic fungal rhinosinusitis has previously demonstrated acceptable interrater reliability among rhinologists. There are, however, numerous learners involved in patient care at tertiary centers. This study aims to analyze the interrater and intrarater reliability of this system among learners in otolaryngology at different stages in training.


METHODS
A prospective analysis of retrospectively collected endoscopic photographs.


METHODS
A tertiary care teaching hospital (January 2013).


METHODS
Fifty patients undergoing routine follow-up.


METHODS
Three photographs from each of 50 patients undergoing routine postsurgical nasoendoscopy were reviewed. Images were played twice, 1 week apart, in 2 differently randomized cycles and scored according to Philpott-Javer criteria by a rhinologist, a rhinology fellow, a senior otolaryngology resident, a junior otolaryngology resident, and a medical student. Interobserver reliability was assessed using the intraclass correlation coefficient, while intrarater reliability was assessed by Shrout-Fleiss κ values. Agreement between each learner and the rhinologist was also assessed using κ values.


RESULTS
The interclass correlation among the 5 raters was 0.7600 (95% confidence interval, 0.6917-0.8161) for the Philpott-Javer scoring system, suggesting substantial reliability. Intrarater data showed substantial to almost-perfect reliability (κ values between 0.668 and 0.815) among all raters using this system. There was also moderate to substantial agreement between the learners and the rhinologist (κ values between 0.534 and 0.710).


CONCLUSIONS
Results suggest that the Philpott-Javer staging system has acceptable intrarater and interrater reliability among learners of differing levels of clinical experience and is suitable for evaluating progress following surgery.
St Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Harman S
HS
Parhar
Andrew
A
Thamboo
Al-Rahim
AR
Habib
Brent
B
Chang
Eng Cern
EC
Gan
Amin R
AR
Javer
D000328:Adult; D002983:Clinical Competence; D004724:Endoscopy / Q000193:education* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010036:Otolaryngology / Q000193:education; D011446:Prospective Studies; D015203:Reproducibility of Results; D006255:Rhinitis, Allergic, Seasonal / Q000473:pathology* / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
allergic fungal rhinosinusitis; endoscopic sinus surgery; endoscopy; residency training