title: Validation of pharyngeal findings on sleep nasopharyngoscopy in children with snoring/sleep disordered breathing.
abstract: OBJECTIVE
  To validate the pharyngeal findings in sleep nasopharyngoscopy (SNP) of children with snoring - sleep disordered breathing (S-SDB).
  
  
  METHODS
  Prospective agreement diagnostic study on retrospective data.
  
  
  METHODS
  We conducted an inter-and intra-rater agreement study on video documentations of SNP performed on children (non-syndromic, complex, or operated upon) who presented with S-SDB. The videos featured various pharyngeal findings (normal, collapse, mixed or obstruction). Three 'non-expert' raters at various stages in their otolaryngological careers rated the videos independently, and on two separate occasions following an instructional session. We calculated both weighted and non-weighted linear kappa.
  
  
  RESULTS
  Each independent observer rated sixty-one videos (2 weeks apart). Intra-observer agreement was 0.64 ± 0.08 (95% CI 0.48-0.81), 0.74 ± 0.07 (95% CI 0.60-0.88), 0.59 ± 0.08 (95% CI 0.43-0.74), for raters 1, two and three. Weighted kappa was 0.6 ± 0.1 (95% CI 0.41-0.79), 0.8 ± 0.06 (95% CI 0.7-0.92), 0.7 ± 0.07 (95% CI 0.57-0.83), respectively. Inter-rater agreements between raters one and two, two and three, three and four were 0.83 ± 0.06 (95% CI 0.71-0.95), 0.52 ± 0.08 (95% CI 0.36-0.70), and 0.53 ± 0.08 (95% CI 0.37-0.69), respectively. Weighted kappa was 0.83 ± 0.073 (95% CI 0.69-0.98), 0.68 ± 0.06 (95% CI 0.56-0.79), and 0.64 ± 0.07 (95% CI 0.49-0.78), respectively.
  
  
  CONCLUSIONS
  This is the first validation of pharyngeal findings on SNP in children. It is based on a four types' classification. Overall reproducibility amongst the three raters and their agreement was moderate to good. Further work should be phase four trials investigating the impact on outcome.
authors.forename: Maleka
authors.initials: M
authors.lastname: Ramji
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Biron
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Jeffery
authors.forename: David W J
authors.initials: DW
authors.lastname: Côté
authors.affiliation: Division of Pediatric Surgery, The Stollery Children's Hospital, University of Alberta Hospitals, 2C3,57 Walter MacKenzie Centre, Edmonton, T6G 2R7 AB Canada. hamdy.elhakim@albertahealthservices.ca.
authors.forename: Hamdy
authors.initials: H
authors.lastname: El-Hakim
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D009305:Nasopharynx; D010614:Pharynx / Q000503:physiopathology*; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D012913:Snoring; D014068:Tonsillectomy