International Pediatric Otolaryngology Group (IPOG) consensus on scoring of pediatric Drug Induced Sleep Endoscopy (DISE)

Sanjay R Parikh; An Boudewyns; Norman R Friedman; Seth Roslow Schwartz; Cristina M Baldassari; Palma Benedek; Michele M Carr; Dylan K Chan; Kate C Chan; Alan T Cheng; Vincent Couloigner; Obinna R Diala; Ari DeRowe; Hamdy El-Hakim; Pierre Fayoux; Wei-Chung Hsu; Stacey Ishman; Erin M Kirkham; Ron B Mitchell; Ravi Thevasagayam; Derek Lam

doi:10.1016/j.ijporl.2023.111627

International Pediatric Otolaryngology Group (IPOG) consensus on scoring of pediatric Drug Induced Sleep Endoscopy (DISE)

Int J Pediatr Otorhinolaryngol. 2023 Aug:171:111627. doi: 10.1016/j.ijporl.2023.111627. Epub 2023 Jun 9.

Authors

Sanjay R Parikh¹, An Boudewyns², Norman R Friedman³, Seth Roslow Schwartz⁴, Cristina M Baldassari⁵, Palma Benedek⁶, Michele M Carr⁷, Dylan K Chan⁸, Kate C Chan⁹, Alan T Cheng¹⁰, Vincent Couloigner¹¹, Obinna R Diala³, Ari DeRowe¹², Hamdy El-Hakim¹³, Pierre Fayoux¹⁴, Wei-Chung Hsu¹⁵, Stacey Ishman¹⁶, Erin M Kirkham¹⁷, Ron B Mitchell¹⁸, Ravi Thevasagayam¹⁹, Derek Lam²⁰

Affiliations

¹ Department of Otolaryngology, University of Washington, Seattle Children's Hospital, USA. Electronic address: [email protected].
² Department of Otolaryngology, Antwerp University Hospital, University of Antwerp, Belgium.
³ Department of Otolaryngology, University of Colorado, Children's Hospital Colorado, USA.
⁴ Department of Otolaryngology, University of Washington, Virginia Mason Hospital, Seattle, USA.
⁵ Department of Otolaryngology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, USA.
⁶ Department of Otolaryngology, Heim Pal National Pediatric Institute, Hungary.
⁷ Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA.
⁹ Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China.
¹⁰ Department of Otolaryngology, The University of Sydney, The Children's Hospital at Westmead, Australia.
¹¹ Department of Otolaryngology, Hôpital Necker-Enfants Malades, Université Paris Cité, France.
¹² Department of Otolaryngology Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Israel.
¹³ Department of Otolaryngology, University of Alberta, Stollery Children's Hospital, Canada.
¹⁴ Pediatric Otolaryngology - Head Neck Surgery, Jeanne de Flandre Hospital, CHU Lille, France.
¹⁵ Department of Otolaryngology, National Taiwan University Hospital and Children's Hospital, Taiwan.
¹⁶ Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, USA.
¹⁷ Department of Otolaryngology, University of Michigan, Mott Children's Hospital, USA.
¹⁸ Department of Otolaryngology, University of Texas, Southwestern Medical Center, Children's Medical Center Dallas, USA.
¹⁹ Department of Otolaryngology, Sheffield Children's Hospital, United Kingdom.
²⁰ Department of Otolaryngology, Oregon Health and Science University, USA.

PMID: 37441992
DOI: 10.1016/j.ijporl.2023.111627

Abstract

Objectives: To develop consensus statements for the scoring of pediatric drug induced sleep endoscopy in the diagnosis and management of pediatric obstructive sleep apnea.

Methods: The leadership group identified experts based on defined criteria and invited 18 panelists to participate in the consensus statement development group. A modified Delphi process was used to formally quantify consensus from opinion. A modified Delphi priori process was established, which included a literature review, submission of statements by panelists, and an iterative process of voting to determine consensus. Voting was based on a 9-point Likert scale. Statements achieving a mean score greater than 7 with one or fewer outliers were defined as reaching consensus. Statements achieving a mean score greater than 6.5 with two or fewer outliers were defined as near consensus. Statements with lower scores or more outliers were defined as no consensus.

Results: A total of 78 consensus statements were evaluated by the panelists at the first survey - 49 achieved consensus, 18 achieved near consensus, and 11 did not achieve consensus. In the second survey, 16 statements reached consensus and 5 reached near consensus. Regarding scoring, consensus was achieved on the utilization of a 3-point Likert scale for each anatomic site for maximal observed obstructions of <50% (Score 0, no-obstruction), ≥ 50% but <90% (Score 2, partial obstruction), and ≥ 90% (Score 3, complete obstruction). Anatomic sites to be scored during DISE that reached consensus or near-consensus were the nasal passages, adenoid pad, velum, lateral pharyngeal walls, tonsils (if present), tongue base, epiglottis, and arytenoids.

Conclusion: This study developed consensus statements on the scoring of DISE in pediatric otolaryngology using a modified Delphi process. The use of a priori process, literature review, and iterative voting method allowed for the formal quantification of consensus from expert opinion. The results of this study may provide guidance for standardizing scoring of DISE in pediatric patients.

Keywords: Consensus; Endoscopy; Pediatric; Scoring; Sleep.

Publication types

Consensus Development Conference

MeSH terms

Child
Endoscopy* / methods
Humans
Pharynx
Polysomnography / methods
Sleep
Sleep Apnea, Obstructive* / diagnosis