Diagnosis of allergic rhinitis: Inter-rater reliability and predictive value of nasal endoscopic examination: A prospective observational study
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2013
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Abstract
Objective: To determine the inter-rater reliability of nasal endoscopic findings and the feasibility of diagnosis of allergic rhinitis based solely on symptoms and nasal endoscopy. Design: Prospective observational study. Setting: University Teaching hospital. Participants: One hundred and eight patients were referred from the allergy clinic included in the study. Main outcome measures: Predictive value of symptoms and nasal endoscopic examination to diagnose allergic rhinitis and inter-rater reliability of the examination were evaluated. Results: Logistic regression analysis of patient symptoms and nasal examination findings revealed no significant predictive power for any of the symptoms or examination findings. The Fleiss κ coefficient of the three raters was calculated. Inter-rater variability among the three physicians demonstrated that mucosal oedema (κ = 0,48, P < 0.001), polypoid degeneration of the inferior turbinate tail (κ = 0.48, P = 0.01), nasal polyps (κ = 0.96, P < 0.001) and nasal septal deviation (κ = 0.65, P = 0.01) showed significant inter-rater agreement. A low κ coefficient (0.29) was found, and the inter-rater variability among physicians in interpreting the characteristics of nasal secretions was significant (P = 0.04). The inter-rater variability among the three physicians suggested that turbinate hypertrophy (κ = 0.31) and turbinate colour (κ = 0.38) showed no significant inter-rater agreement. Conclusions: Patient symptoms and nasal endoscopy findings do not provide reliable diagnosis of allergic rhinitis. Turbinate colour and hypertrophy are believed to be related to allergic rhinitis; however, these were subject to marked inter-rater variability in this study. © 2013 John Wiley & Sons Ltd 38 6 December 2013 10.1111/coa.12171 Original Article Original Articles © 2013 John Wiley & Sons Ltd.
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Adult , Diagnosis, Differential , Endoscopy , Female , Humans , Male , Nose , Prospective Studies , Reproducibility of Results , Rhinitis, Allergic , ROC Curve , Turbinates , adult , allergic rhinitis , article , asthma , color , dysphonia , edema , endoscopy , female , human , hypertrophy , interrater reliability , major clinical study , male , nasal endoscopy , nose obstruction , nose polyp , nose secretion , nose septum , observational study , predictive value , priority journal , pruritus , rhinorrhea , sensitivity and specificity , turbinate , differential diagnosis , endoscopy , nose , pathology , procedures , prospective study , receiver operating characteristic , reproducibility , Rhinitis, Allergic