Validation of a clinical assessment score for pediatric sleep-disordered breathing

Nira A. Goldstein, Dimitre G. Stefanov, Katharina D. Graw-Panzer, Samir A. Fahmy, Sherry Fishkin, Alison Jackson, Jennifer S. Sarhis, Jeremy Weedon

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objectives/Hypothesis: To validate a clinical assessment score for pediatric sleep-disordered breathing. Study Design: Prospective instrument validation. Methods: One hundred children scheduled for overnight polysomnography were evaluated by a standardized history and physical examination and assigned a clinical assessment score. Parents completed the Obstructive Sleep Apnea (OSA)-18, the Pediatric Quality of Life Inventory (PedsQL) 4.0, and the Child Behavior Checklist questionnaires. Children with positive polysomnography underwent adenotonsillectomy or adenoidectomy. The identical assessments were performed at a mean follow-up of 8 months. Results: Item reduction yielded a score of 15 items (Clinical Assessment Score-15 [CAS-15]) that demonstrated the best internal consistency and predictive utility (Cronbach α =.80). Intraclass correlation (ICC) demonstrated good intrarater (ICC, 0.78; 95% confidence interval [CI], 0.58 to 0.89) and inter-rater agreement (ICC, 0.65; 95% CI, 0.26 to 0.84). All change scores were significantly improved after surgery. Effect sizes were large for the CAS-15 (2.6), OSA-18 (2.4), and apnea-hypopnea index (1.4), and moderate for the Child Behavior Checklist (0.7) and PedsQL 4.0 (-0.5). Moderate to strong correlation was found between the initial CAS-15 scores and the external measures (|r| between 0.32 and 0.65). Receiver operating characteristic curves were constructed to determine the optimal initial CAS-15 score for predicting positive polysomnography. The area under the curve was 0.77 (95% CI, 0.67 to 0.87); and a score ≥32 yielded a sensitivity of 77.3% (95% CI, 65.3 to 86.7) and a specificity of 60.7% (95% CI, 40.6 to 78.5). Conclusions: The CAS-15 proved useful in an office setting and correctly diagnosed 72% of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.

Original languageEnglish (US)
Pages (from-to)2096-2104
Number of pages9
JournalLaryngoscope
Volume122
Issue number9
DOIs
StatePublished - Sep 2012
Externally publishedYes

Fingerprint

Sleep Apnea Syndromes
Polysomnography
Confidence Intervals
Pediatrics
Child Behavior
Obstructive Sleep Apnea
Checklist
Adenoidectomy
Apnea
ROC Curve
Physical Examination
Area Under Curve
Parents
History
Quality of Life
Prospective Studies
Equipment and Supplies

Keywords

  • diagnosis
  • obstructive sleep apnea
  • pediatrics
  • polysomnography
  • Sleep-disordered breathing

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Goldstein, N. A., Stefanov, D. G., Graw-Panzer, K. D., Fahmy, S. A., Fishkin, S., Jackson, A., ... Weedon, J. (2012). Validation of a clinical assessment score for pediatric sleep-disordered breathing. Laryngoscope, 122(9), 2096-2104. https://doi.org/10.1002/lary.23455

Validation of a clinical assessment score for pediatric sleep-disordered breathing. / Goldstein, Nira A.; Stefanov, Dimitre G.; Graw-Panzer, Katharina D.; Fahmy, Samir A.; Fishkin, Sherry; Jackson, Alison; Sarhis, Jennifer S.; Weedon, Jeremy.

In: Laryngoscope, Vol. 122, No. 9, 09.2012, p. 2096-2104.

Research output: Contribution to journalArticle

Goldstein, NA, Stefanov, DG, Graw-Panzer, KD, Fahmy, SA, Fishkin, S, Jackson, A, Sarhis, JS & Weedon, J 2012, 'Validation of a clinical assessment score for pediatric sleep-disordered breathing', Laryngoscope, vol. 122, no. 9, pp. 2096-2104. https://doi.org/10.1002/lary.23455
Goldstein NA, Stefanov DG, Graw-Panzer KD, Fahmy SA, Fishkin S, Jackson A et al. Validation of a clinical assessment score for pediatric sleep-disordered breathing. Laryngoscope. 2012 Sep;122(9):2096-2104. https://doi.org/10.1002/lary.23455
Goldstein, Nira A. ; Stefanov, Dimitre G. ; Graw-Panzer, Katharina D. ; Fahmy, Samir A. ; Fishkin, Sherry ; Jackson, Alison ; Sarhis, Jennifer S. ; Weedon, Jeremy. / Validation of a clinical assessment score for pediatric sleep-disordered breathing. In: Laryngoscope. 2012 ; Vol. 122, No. 9. pp. 2096-2104.
@article{9ce39283f4ca42a491e24a47e634e4ff,
title = "Validation of a clinical assessment score for pediatric sleep-disordered breathing",
abstract = "Objectives/Hypothesis: To validate a clinical assessment score for pediatric sleep-disordered breathing. Study Design: Prospective instrument validation. Methods: One hundred children scheduled for overnight polysomnography were evaluated by a standardized history and physical examination and assigned a clinical assessment score. Parents completed the Obstructive Sleep Apnea (OSA)-18, the Pediatric Quality of Life Inventory (PedsQL) 4.0, and the Child Behavior Checklist questionnaires. Children with positive polysomnography underwent adenotonsillectomy or adenoidectomy. The identical assessments were performed at a mean follow-up of 8 months. Results: Item reduction yielded a score of 15 items (Clinical Assessment Score-15 [CAS-15]) that demonstrated the best internal consistency and predictive utility (Cronbach α =.80). Intraclass correlation (ICC) demonstrated good intrarater (ICC, 0.78; 95{\%} confidence interval [CI], 0.58 to 0.89) and inter-rater agreement (ICC, 0.65; 95{\%} CI, 0.26 to 0.84). All change scores were significantly improved after surgery. Effect sizes were large for the CAS-15 (2.6), OSA-18 (2.4), and apnea-hypopnea index (1.4), and moderate for the Child Behavior Checklist (0.7) and PedsQL 4.0 (-0.5). Moderate to strong correlation was found between the initial CAS-15 scores and the external measures (|r| between 0.32 and 0.65). Receiver operating characteristic curves were constructed to determine the optimal initial CAS-15 score for predicting positive polysomnography. The area under the curve was 0.77 (95{\%} CI, 0.67 to 0.87); and a score ≥32 yielded a sensitivity of 77.3{\%} (95{\%} CI, 65.3 to 86.7) and a specificity of 60.7{\%} (95{\%} CI, 40.6 to 78.5). Conclusions: The CAS-15 proved useful in an office setting and correctly diagnosed 72{\%} of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.",
keywords = "diagnosis, obstructive sleep apnea, pediatrics, polysomnography, Sleep-disordered breathing",
author = "Goldstein, {Nira A.} and Stefanov, {Dimitre G.} and Graw-Panzer, {Katharina D.} and Fahmy, {Samir A.} and Sherry Fishkin and Alison Jackson and Sarhis, {Jennifer S.} and Jeremy Weedon",
year = "2012",
month = "9",
doi = "10.1002/lary.23455",
language = "English (US)",
volume = "122",
pages = "2096--2104",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - Validation of a clinical assessment score for pediatric sleep-disordered breathing

AU - Goldstein, Nira A.

AU - Stefanov, Dimitre G.

AU - Graw-Panzer, Katharina D.

AU - Fahmy, Samir A.

AU - Fishkin, Sherry

AU - Jackson, Alison

AU - Sarhis, Jennifer S.

AU - Weedon, Jeremy

PY - 2012/9

Y1 - 2012/9

N2 - Objectives/Hypothesis: To validate a clinical assessment score for pediatric sleep-disordered breathing. Study Design: Prospective instrument validation. Methods: One hundred children scheduled for overnight polysomnography were evaluated by a standardized history and physical examination and assigned a clinical assessment score. Parents completed the Obstructive Sleep Apnea (OSA)-18, the Pediatric Quality of Life Inventory (PedsQL) 4.0, and the Child Behavior Checklist questionnaires. Children with positive polysomnography underwent adenotonsillectomy or adenoidectomy. The identical assessments were performed at a mean follow-up of 8 months. Results: Item reduction yielded a score of 15 items (Clinical Assessment Score-15 [CAS-15]) that demonstrated the best internal consistency and predictive utility (Cronbach α =.80). Intraclass correlation (ICC) demonstrated good intrarater (ICC, 0.78; 95% confidence interval [CI], 0.58 to 0.89) and inter-rater agreement (ICC, 0.65; 95% CI, 0.26 to 0.84). All change scores were significantly improved after surgery. Effect sizes were large for the CAS-15 (2.6), OSA-18 (2.4), and apnea-hypopnea index (1.4), and moderate for the Child Behavior Checklist (0.7) and PedsQL 4.0 (-0.5). Moderate to strong correlation was found between the initial CAS-15 scores and the external measures (|r| between 0.32 and 0.65). Receiver operating characteristic curves were constructed to determine the optimal initial CAS-15 score for predicting positive polysomnography. The area under the curve was 0.77 (95% CI, 0.67 to 0.87); and a score ≥32 yielded a sensitivity of 77.3% (95% CI, 65.3 to 86.7) and a specificity of 60.7% (95% CI, 40.6 to 78.5). Conclusions: The CAS-15 proved useful in an office setting and correctly diagnosed 72% of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.

AB - Objectives/Hypothesis: To validate a clinical assessment score for pediatric sleep-disordered breathing. Study Design: Prospective instrument validation. Methods: One hundred children scheduled for overnight polysomnography were evaluated by a standardized history and physical examination and assigned a clinical assessment score. Parents completed the Obstructive Sleep Apnea (OSA)-18, the Pediatric Quality of Life Inventory (PedsQL) 4.0, and the Child Behavior Checklist questionnaires. Children with positive polysomnography underwent adenotonsillectomy or adenoidectomy. The identical assessments were performed at a mean follow-up of 8 months. Results: Item reduction yielded a score of 15 items (Clinical Assessment Score-15 [CAS-15]) that demonstrated the best internal consistency and predictive utility (Cronbach α =.80). Intraclass correlation (ICC) demonstrated good intrarater (ICC, 0.78; 95% confidence interval [CI], 0.58 to 0.89) and inter-rater agreement (ICC, 0.65; 95% CI, 0.26 to 0.84). All change scores were significantly improved after surgery. Effect sizes were large for the CAS-15 (2.6), OSA-18 (2.4), and apnea-hypopnea index (1.4), and moderate for the Child Behavior Checklist (0.7) and PedsQL 4.0 (-0.5). Moderate to strong correlation was found between the initial CAS-15 scores and the external measures (|r| between 0.32 and 0.65). Receiver operating characteristic curves were constructed to determine the optimal initial CAS-15 score for predicting positive polysomnography. The area under the curve was 0.77 (95% CI, 0.67 to 0.87); and a score ≥32 yielded a sensitivity of 77.3% (95% CI, 65.3 to 86.7) and a specificity of 60.7% (95% CI, 40.6 to 78.5). Conclusions: The CAS-15 proved useful in an office setting and correctly diagnosed 72% of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.

KW - diagnosis

KW - obstructive sleep apnea

KW - pediatrics

KW - polysomnography

KW - Sleep-disordered breathing

UR - http://www.scopus.com/inward/record.url?scp=84865632818&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865632818&partnerID=8YFLogxK

U2 - 10.1002/lary.23455

DO - 10.1002/lary.23455

M3 - Article

C2 - 22890967

AN - SCOPUS:84865632818

VL - 122

SP - 2096

EP - 2104

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

IS - 9

ER -