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Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction

Emil Schwarz Walsted, James H. Hull, Jeppe Hvedstrup, Robert Christiaan Maat, Vibeke Backer
ERJ Open Research 2017 3: 00070-2017; DOI: 10.1183/23120541.00070-2017
Emil Schwarz Walsted
1Respiratory Research Unit, Dept of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
2Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
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  • ORCID record for Emil Schwarz Walsted
  • For correspondence: emilwalsted@dadlnet.dk
James H. Hull
2Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
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Jeppe Hvedstrup
1Respiratory Research Unit, Dept of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Robert Christiaan Maat
3Dept of Otorhinolaryngology, Röpcke-Zweers Hospital, Hardenberg, The Netherlands
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Vibeke Backer
1Respiratory Research Unit, Dept of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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  • FIGURE 1
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    FIGURE 1

    The grading system illustrated by photographic images of the larynx showing the different grades of laryngeal obstruction at the glottic and supraglottic levels. #: the scores at each level (glottic (A and C) and supraglottic (B and D)) were assessed at moderate (A, B) (when the subject started to run) and at maximal (C, D) (just before the subject stopped running on the treadmill) effort; all four levels (A–D) were noted together with a sum score (E) for each test/subject. Reproduced from [11] with permission from the publisher.

  • FIGURE 2
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    FIGURE 2

    Diagnostic implications: one or more changes in exercise-induced laryngeal obstruction diagnosis (i.e. having or not having clinically significant laryngeal obstruction at either the glottic or the supraglottic level) over the course of the four tests. In a secondary analysis, the first test was excluded from analysis to depict implications due to intra-rater and test–retest variation only (i.e. excluding any learning effect; see also figure 3).

  • FIGURE 3
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    FIGURE 3

    Learning effect on test duration. Data are presented as predicted means±se from a linear mixed model of group and time as predictors of test duration. EILO: exercise-induced laryngeal obstruction. *: p<0.05.

Tables

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  • TABLE 1

    Subject characteristics

    Sex n (%)
     Female19 (83)
     Male4 (17)
    Age years median (range)23 (15–45)
    Body mass index kg·m−221.1 (4.6)
    FEV1 L3.50 (1.2)
    FEV1 % pred98.7 (25)
    FVC L4.30 (1.2)
    FVC % pred103.3 (26.1)

    Data are presented as median (interquartile range), unless otherwise stated. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity.

    • TABLE 2

      Test–retest reliability of exercise-induced laryngeal obstruction grade scores and time to onset

      Tests 1 and 2Tests 2 and 3Tests 3 and 4
      Cohen's ϰ (95% CI)ICC (95% CI)Cohen's ϰ (95% CI)ICC (95% CI)Cohen's ϰ (95% CI)ICC (95% CI)
      Glottic scores0.49 (0.32–0.67)0.52 (0.35–0.70)0.40 (0.23–0.57)
      Supraglottic scores0.31 (0.07–0.55)0.45 (0.25–0.65)0.58 (0.41–0.76)
      Time to onset0.61 (0.37–0.77)0.86 (0.73–0.92)0.79 (0.61–0.89)

      ICC: intraclass correlation coefficient (2,1), single measures.

      • TABLE 3

        Inter-rater agreement on exercise-induced laryngeal obstruction grade scores and time to onset

        Raters 1 and 2Raters 2 and 3Raters 3 and 1
        Cohen's ϰ (95% CI)ICC (95% CI)Cohen's ϰ (95% CI)ICC (95% CI)Cohen's ϰ (95% CI)ICC (95% CI)
        Glottic scores0.16 (0.03–0.29)0.45 (0.30–0.59)0.16 (0.08–0.25)
        Supraglottic scores0.42 (0.27–0.57)0.40 (0.20–0.60)0.30 (0.15–0.44)
        Time to onset0.54 (0.29–0.72)0.56 (0.00–0.80)0.55 (0.36–0.70)

        ICC: intraclass correlation coefficient (2,1), single measures.

        • TABLE 4

          Intra-rater agreement on exercise-induced laryngeal obstruction grade scores and time to onset

          Glottic scoresSupraglottic scoresTime to onset
          ϰ (95% CI)ϰ (95% CI)ICC (95% CI)
          Rater 10.30 (0.10–0.49)0.41 (0.27–0.55)0.45 (0.23–0.62)
          Rater 20.48 (0.31–0.64)0.56 (0.40–0.71)0.85 (0.74–0.92)
          Rater 30.67 (0.56–0.79)0.43 (0.23–0.63)0.43 (0.22–0.60)
          All raters0.58 (0.49–0.66)0.48 (0.39–0.57)0.51 (0.39–0.61)

          ICC: intraclass correlation coefficient (2,1), single measures.

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          Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
          Emil Schwarz Walsted, James H. Hull, Jeppe Hvedstrup, Robert Christiaan Maat, Vibeke Backer
          ERJ Open Research Jul 2017, 3 (3) 00070-2017; DOI: 10.1183/23120541.00070-2017

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          Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction
          Emil Schwarz Walsted, James H. Hull, Jeppe Hvedstrup, Robert Christiaan Maat, Vibeke Backer
          ERJ Open Research Jul 2017, 3 (3) 00070-2017; DOI: 10.1183/23120541.00070-2017
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