Development and validation of the international pediatric sleep endoscopy scale (IPSES)

Objectives: To develop and validate a consensus international pediatric sleep endoscopy scale (IPSES) for pediatric drug-induced sleep endoscopy (DISE). Methods: Existing published DISE ratings scales were reviewed in order to develop a consensus rating scale synthesizing the most common features and adding new elements to address areas of controversy. Samples of 30 de-identified DISE video recordings were reviewed to develop and refine the scale. After the consensus scale was defined, a separate sample of 25 de-identified DISE videos were scored with the new consensus scale by the development group and a panel of independent raters. A weighted kappa statistic was used to quantify the inter-rater and intra-rater reliability of the consensus scale at each anatomic level. Results: Among all raters, intra-rater reliability was most variable for the nasal airway (kappa range 0.33–0.94) and best for the lateral oropharynx (kappa range 0.68–0.95). Inter-rater reliability ranged from 0.43 for the nasal airway to 0.57 at the soft palate. Conclusion: The IPSES is a reliable consensus scale that reflects the most common features of existing scales and can be adopted as a universal scoring scale for pediatric DISE.