Supraglottic index, teaching program validated

Dec 10 2013

By Joanna Lyford, Senior medwireNews Reporter

A scoring system known as the supraglottic index (SGI) is valuable in assessing patients with asthma complicated by laryngopharyngeal reflux, researchers report.

The team behind the SGI also developed an online training system to help pulmonologists to use the score and showed that it allowed highly reproducible assessment and scoring of supraglottic abnormalities.

“The SGI can be used to determine which patients need additional intervention to determine causes of [laryngopharyngeal reflux] and gastroesophageal reflux,” write Richard Martin (National Jewish Health, Denver, Colorado, USA) and fellow authors of the SGI training program.

“Although an initial labor-intensive period is needed for any naïve reader to become proficient in the SGI scoring system, the effort pays off in better classification and thus treatment of refractory asthma patients,” they add.

In earlier work, Martin’s team developed the SGI as an objective measure of supraglottic abnormalities. The score assigns points for the amount of edema, erythema, and hyperemia present in three supraglottic structures (epiglottis, false cords, and arytenoids), and for appearance of the posterior commissure and the piriform recesses.

In this study, the team assessed intra- and inter-observer reproducibility of the SGI when applied by five pulmonologists with expertise in fiberoptic bronchoscopy but no prior knowledge of the SGI.

All pulmonologists underwent structured training in using the SGI, comprising an educational lecture followed by four practical sessions in which they reviewed and scored photographs of supraglottic structures, followed by discussion with an SGI-experienced reader. In the final session, no discussion was allowed and photographs were scored independently.

Writing in Chest, Martin et al report that inter-reader agreement increased as the pulmonologists gained experience in using the SGI. By the final scoring session, agreement using an SGI cutoff of 10 was “excellent,” with a kappa of at least 0.81, thereby confirming the reproducibility of the index.

Intra-observer consistency was also excellent, with a kappa value of 0.93 for the same photographs scored by the same reader 4 weeks apart.

Noting that laryngopharyngeal reflux is an important risk factor for a multitude of pulmonary conditions, Martin et al comment: “We now have an extensive online educational teaching program for learning to score the SGI.”

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