Reliability of upper respiratory tract endoscopic grading in horses

• Autores: C.L. McGivney, J. Sweeney, F. David, J.M. O Leary, E.W. Hill, L.M. Katz
• Localización: Veterinary Record, ISSN-e 2042-7670, Vol. 180, Nº. 6, 2017
• Idioma: inglés
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• Resumen

  • 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.