Rapid, simultaneous comparison system for subjective grading scales for facial paralysis

Objective: The senior authors developed a computer-assisted rapid, simultaneous comparison system for nine international grading scales for facial paralysis. The purpose of this study is to present the system and to compare the agreement of hand-performed House-Brackmann and Sunnybrook scales, two frequently used scales herein taken as the concurrent criterion test standards, with those like scales done simultaneously in the computed system. Study Design: The study design was a prospective concurrent criterion validity study. Test-retest reliability and interobserver agreement were assessed using the kappa statistic (k) for ordinal data and the intraclass correlation coefficient (ICC) for semidimensional data. Setting: The study was conducted at a university practice. Patients: Ten consecutive consenting subjects with varying degrees of facial paralysis were studied. Intervention: Each subject was measured, in random order, twice by each method by each of two independent observers. Main Outcome Measures: House-Brackmann score, Sunnybrook score, and like-scale scores done simultaneously in the computed system were measured. Results: Agreement between the computed system and hand-performed criterion standards was equal to each scale compared against itself; for the House-Brackmann, agreement was moderate (k = 0.554); for the Sunnybrook, agreement was excellent (ICC = 0.976). Conclusions: The computed system has the advantage of allowing an examiner to view a rapid, simultaneous display of multiple grading scale scores at a keystroke from one clinical assessment input, obviating the labor of repeating measures by hand.