Reliability of upper respiratory tract endoscopic grading in horses
2017
Endoscopic evaluation of disorders of the structure and function
of the equine upper respiratory tract (URT) are typically assessed
through the use of ordinal grading systems described for each
individual condition. In order to effectively draw conclusions about
the presence and severity of any URT condition, it is important to
determine that grading systems can be used in a comparable way with
minimal variability.
The objective of the current study was to determine estimates
of intra- and interobserver reliability for identification and grading
of URT disorders during evaluation of resting and overground
endoscopic (OGE) videos of thoroughbred horses.
Resting and OGE URT videos for 43 thoroughbreds were
retrospectively chosen based on identification of common URT
disorders. The videos were randomly evaluated in duplicate by four
clinicians blinded to previous medical history and graded according to
previously defined scales. Intraobserver and interobserver reliability
were statistically evaluated.
Intraobserver agreement was perfect/nearly perfect for arytenoid
symmetry at exercise, epiglottic entrapment and epiglottic retroversion;
substantial for arytenoid asymmetry at rest, palatal dysfunction,
medial deviation of the aryepiglottic folds, pharyngeal mucus and
epiglottic grade at exercise; and moderate for vocal fold collapse,
ventromedial luxation of the apex of the corniculate process of the
arytenoid (VLAC), nasopharyngeal collapse and epiglottic grade at
rest. Interobserver agreement was substantial for arytenoid symmetry
at exercise and palatal dysfunction; and moderate for arytenoid
asymmetry at rest, medial deviation of the aryepiglottic folds, VLAC
and epiglottic entrapment. It was only fair for vocal fold collapse,
epiglottic grade at exercise, epiglottic retroversion, pharyngeal mucus
and nasopharyngeal collapse; and was poor for epiglottic grade at rest.
The authors conclude that although clinicians are consistent in
the grading of most URT conditions, interobserver reliability could
be improved by clinician training and more defined grading systems,
especially for conditions of the epiglottis.
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