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The Generalizability of the Clinical Assessment Score‐15 for Pediatric Sleep‐Disordered Breathing
Author(s) -
Goldstein Nira A.,
Friedman Norman R.,
Nardone Heather C.,
Aljasser Abdullah,
Tobey Allison B.J.,
Don Debra,
Baroody Fuad M.,
Lam Derek J.,
Goudy Steven,
Ishman Stacey L.,
Arganbright Jill M.,
Baldassari Cristina,
Schreinemakers J.B.S.,
Wine Todd M.,
Ruszkay Nicole J.,
Alammar Ahmed,
Shaffer Amber D.,
Koempel Jeffrey A.,
Weedon Jeremy
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28428
Subject(s) - medicine , polysomnography , generalizability theory , confidence interval , receiver operating characteristic , area under the curve , sleep disordered breathing , sleep apnea , apnea , pediatrics , physical therapy , obstructive sleep apnea , psychology , developmental psychology
Objective The Clinical Assessment Score‐15 (CAS‐15) has been validated as an office‐based assessment for pediatric sleep‐disordered breathing in otherwise healthy children. Our objective was to determine the generalizability of the CAS‐15 in a multi‐institutional fashion. Methods Five hundred and thirty children from 13 sites with suspected sleep‐disordered breathing were recruited, and the investigators completed the CAS‐15. Based on decisions made in the course of clinical care, investigators recommended overnight polysomnography, observation, medical therapy, and/or surgery. Two hundred and forty‐seven subjects had a follow‐up CAS‐15. Results Mean age was 5.1 (2.6) years; 54.2% were male; 39.1% were white; and 37.0% were African American. Initial mean (standard deviation [SD]) CAS‐15 was 37.3 (12.7), n = 508. Spearman correlation between the initial CAS‐15 and the initial apnea‐hypopnea index (AHI) was 0.41 (95% confidence interval [CI], 0.29, 0.51), n = 212, P < .001. A receiver‐operating characteristic curve predicting positive polysomnography (AHI > 2) had an area under the curve of 0.71 (95% CI, 0.63, 0.80). A score ≥ 32 had a sensitivity of 69.0% (95% CI, 61.7, 75.5), a specificity of 63.4% (95% CI, 47.9, 76.6), a positive predictive value of 88.7% (95% CI, 82.1, 93.1), and a negative predictive value of 32.9% (95% CI, 23.5, 44.0) in predicting positive polysomnography. Among children who underwent surgery, the mean change (SD) score was 30.5 (12.6), n = 201, t = 36.85, P < .001, effect size = 3.1. Conclusion This study establishes the generalizability of the CAS‐15 as a useful office tool for the evaluation of pediatric sleep‐disordered breathing. Level of Evidence 2B Laryngoscope , 130:2256–2262, 2020