title: Poor interexaminer agreement on Friedman tongue position.
abstract: CONCLUSIONS
  The Friedman tongue position demonstrated only a slight inter-examiner agreement among 15 medical doctors, indicating that the method is difficult to perform and could be an uncertain method to select patients for uvulopalatopharyngoplasty.
  
  
  OBJECTIVE
  The Friedman staging system is a clinical tool for selecting patients with obstructive sleep apnea who are appropriate for uvulopalatopharyngoplasty. The objective of this study was to evaluate the staging system by determining the inter-examiner agreement of one of its key components, the Friedman tongue position.
  
  
  METHODS
  Eleven residents and four specialists in Otorhinolaryngology were recruited from a course in surgical management of obstructive sleep apnea. They examined each other's tongue positions, resulting in a total of 210 evaluations. Cohen's kappa analysis was performed to assess the inter-examiner agreement. The range of kappa is usually between 0-1, where 0 is complete disagreement and 1 is complete agreement.
  
  
  RESULTS
  The median kappa was 0.36 (1st and 3rd quartile, 0.23 and 0.42), corresponding to only a slight agreement.
authors.affiliation: a Department of Otorhinolaryngology , Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Joar
authors.initials: J
authors.lastname: Sundman
authors.affiliation: b Statisticon AB , Stockholm , Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Bring
authors.affiliation: a Department of Otorhinolaryngology , Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Danielle
authors.initials: D
authors.lastname: Friberg
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010036:Otolaryngology / Q000592:standards*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D014059:Tongue
keywords: Cohen kappa; Uvulopalatopharyngoplasty; inter-rater reliability; obstructive sleep apnea; patient selection