Amerjeeth, J D (2020) Comparison of Inter- and Intra-rater reliability of Modified House Brackmann and Sunnybrook Facial Nerve Grading Systems in Post Parotidectomy patients. Masters thesis, Christian Medical College, Vellore.
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Abstract
BACKGROUND: Parotidectomy is one of the common surgical techniques performed for the tumors in the parotid gland and facial nerve paresis is a common postoperative complication. We need an effective and reliable facial nerve grading system to assess the facial nerve function and to compare the various treatment modalities. We have been using a modification of the House Brackmann score since 2008 to include differential scores for functions of temporal, zygomatic and marginal mandibular nerve. Sunny brook is another well-known subjective grading system for facial nerve paresis. Since we have been using a unique modification of the House Brackmann score, we wanted to investigate its reliability against the best alternative that is feasible in our clinical scenario. Hence, we propose to study the inter- and intra-rater reliability of the modified House Brackmann and Sunnybrook systems. OBJECTIVES: 1. To compare inter-rater reliability of Modified House Brackmann and Sunnybrook grading systems. 2. To compare intra-rater reliability of Modified House Brackmann and Sunnybrook grading systems. METHODS: Study design: A prospective study, non-randomized. Patients who underwent unilateral nerve conserving parotidectomy under Surgery Unit I were recruited into the study after consenting and were videotaped during their first post-operative visit to the hospital while performing specific facial movements. These videos were shown to 3 assessors for grading the facial nerve function using the Modified House Brackmann (used in CMC, Vellore) and Sunnybrook facial nerve grading systems and were assessed for the inter- and intra-rater reliability of the two systems. RESULTS: The overall inter-rater agreement in modified House brackmann score was excellent with an ICC of 0.90 (0.84, 0.94). The overall intra-rater reliability of the Modified House brackmann score for the three observers had excellent agreement with ICC ranged between 0.84- 0.97. The overall inter-rater agreement in Sunny Brook scoring system was excellent with an ICC of 0.90 (0.84, 0.94). The overall intra-rater reliability of Sunny brook grading system had excellent agreement with ICC ranged between 0.89- 0.98. CONCLUSION: In our study, we found out that both the Modified House Brackmann score used in our center and the Sunny brook Facial nerve grading systems had excellent inter and intra- rater reliability and there was no statistically significant data to suggest that one system was superior to the other. The advantage of using Modified House Brackmann score used in our center is that unlike the House Brackmann score it gives 3 individual scores for the individual branches of facial nerve. However, Sunny brook system is a more comprehensive system that can amount for features like synkinesis in late form of facial palsy.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711451 |
| Uncontrolled Keywords: | Facial nerve, facial paralysis, facial palsy, facial grading scales, Modified House Brackmann Grading, Sunnybrook Facial Grading System, inter-rater reliability, intra-rater reliability. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Feb 2021 16:35 |
| Last Modified: | 12 Feb 2021 16:35 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14063 |
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