基于视频的睡眠呼吸障碍儿童扁桃体大小评估

文献信息

中文摘要

目的： 评估使用手持远程医疗设备由家长拍摄的口咽部视频，与面对面临床检查相比，能否评估睡眠呼吸障碍儿童的扁桃体大小。
方法： 我们在单一三级儿科转诊中心开展了一项前瞻性诊断准确性研究。连续纳入169名计划接受扁桃体切除术、腺样体切除术或扁桃体腺样体切除术的儿童。家长使用手持远程医疗设备（TytoCare）拍摄口咽部视频。三名设盲的儿科耳鼻咽喉科医师独立使用Brodsky量表对扁桃体大小进行分级。评估了评分者间一致性、相对于面对面检查的诊断性能以及视频可用性。
结果： 在169名儿童中（中位年龄4.4岁，IQR 3.3-7.6），53%接受了扁桃体腺样体切除术，46%仅接受腺样体切除术。扁桃体大小分级的评分者间一致性很强（Kendall's W = 0.88，p < 0.01），当分级二分为0-2与3-4时仍保持显著一致（Fleiss κ = 0.65，95% CI：0.58-0.73）。以面对面检查为参考标准，敏感性为70%，特异性为86%，阳性预测值为84%，阴性预测值为73%。21段视频（12%）被所有评估者判定为不可用，54段（32%）被至少一名评估者判定为不可用，年幼儿童中比例更高。
结论： 家长拍摄的口咽部视频可能为部分睡眠呼吸障碍儿童提供一种可行的远程扁桃体大小评估方法。较强的评分者间一致性和总体良好的家长态度支持进一步评估该方法，但在常规依赖视频评估进行手术决策之前仍需额外验证。

英文摘要

OBJECTIVE: To evaluate whether parent-captured oropharyngeal videos obtained using a handheld telemedicine device can assess tonsil size in children with sleep-disordered breathing compared with in-person clinical examination.
METHODS: We conducted a prospective diagnostic accuracy study at a single tertiary pediatric referral center. A consecutive sample of 169 children scheduled for tonsillectomy, adenoidectomy, or adenotonsillectomy was enrolled. Parents obtained oropharyngeal videos using a handheld telemedicine device (TytoCare). Three blinded pediatric otolaryngologists independently graded tonsil size using the Brodsky scale. Interrater agreement, diagnostic performance relative to in-person examination, and video usability were assessed.
RESULTS: Among 169 children (median age 4.4 years, IQR 3.3-7.6), 53% underwent adenotonsillectomy and 46% adenoidectomy alone. Interrater agreement for tonsil size grading was strong (Kendall's W = 0.88, p < 0.01) and remained substantial when grades were dichotomized as 0-2 versus 3-4 (Fleiss κ = 0.65, 95% CI: 0.58-0.73). Using the in-person examination as the reference standard, sensitivity was 70%, specificity was 86%, positive predictive value was 84%, and negative predictive value was 73%. Twenty-one videos (12%) were unusable by all evaluators and 54 (32%) by at least one evaluator, with higher rates in younger children.
CONCLUSION: Parent-captured oropharyngeal videos may provide a feasible method for remote tonsil size assessment in selected children with sleep-disordered breathing. Strong interrater agreement and generally favorable parental attitudes support further evaluation of this approach, while additional validation is needed before routine reliance on video-based assessment for surgical decision-making.