{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:27:49Z","timestamp":1775816869225,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,4,13]],"date-time":"2020-04-13T00:00:00Z","timestamp":1586736000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the agreement of paediatric otolaryngologists on classifying laryngomalacia (LM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Intra\u2010 and interobserver agreement study of two classification systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three tertiary referral paediatric centres.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Three paediatric otolaryngologists, who were blinded to any clinical details, interpreted the videos of children diagnosed with LM using the Holinger and Olney classifications independently. They rated the videos twice with a washout period of at least 2\u00a0weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>The main outcome measures<\/jats:title><jats:p>Inter\u2010 and intra\u2010observer agreement measured by overall Fleiss kappa and unweighted Cohen's kappa coefficients. The secondary outcome measures were inter\u2010 and intra\u2010observer agreement on the individual anatomical subunits of the supraglottis affected by LM, characterised by the subcategories of the classifications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Video records of infants and children &lt;18\u00a0years who had an endoscopic diagnosis of LM from 2012 to 2017 were retrospectively chosen for inclusion (n\u00a0=\u00a073). The overall Fleiss kappa coefficient was 0.25 (95% CI 0.18\u20100.32) amongst the raters using the Holinger classification and 0.31 (95% CI 0.21\u20100.42) for the Olney classification. Intra\u2010observer agreement using the Holinger classification was 0.30 (95% CI 0.18\u20100.42), 0.62 (95% CI 0.23\u20100.85) and 0.84 (95% CI 0.75\u20100.94], whilst the Olney classification yielded values of 0.41 (95% CI 0.26\u20100.56), 0.51 (95% CI 0.29\u20100.63) and 0.63 (95% CI 0.48\u20100.78).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The agreement on types of LM between expert observers is modest using the Holinger and Olney classifications. This has significant implications for accurately diagnosing LM and exposes potential obstacles against credible pooling of data and extrapolation of information.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13530","type":"journal-article","created":{"date-parts":[[2020,3,21]],"date-time":"2020-03-21T13:15:54Z","timestamp":1584796554000},"page":"471-476","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Validity of laryngomalacia classification systems: A multi\u2010institutional agreement study"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5925-445X","authenticated-orcid":false,"given":"Shanmugappiriya","family":"Sivarajah","sequence":"first","affiliation":[{"name":"Division of Otolaryngology Head &amp; Neck Surgery Division of Pediatric Surgery Department of Surgery University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1551-9588","authenticated-orcid":false,"given":"Andre","family":"Isaac","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head &amp; Neck Surgery Division of Pediatric Surgery Department of Surgery University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelaina","family":"Anderson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine &amp; Dentistry University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Mehta","sequence":"additional","affiliation":[{"name":"Bobby R. Alford Department of Otolaryngology Head and Neck Surgery Baylor College of Medicine Texas Children\u2019s Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8766-3266","authenticated-orcid":false,"given":"Paul","family":"Hong","sequence":"additional","affiliation":[{"name":"Pediatric Otolaryngology Division of Otolaryngology\u2010Head &amp; Neck Surgery Department of Surgery Dalhousie University Halifax Nova Scotia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaser","family":"Alrajhi","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head &amp; Neck Surgery Division of Pediatric Surgery Department of Surgery University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9349-8239","authenticated-orcid":false,"given":"Hamdy","family":"El\u2010Hakim","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head &amp; Neck Surgery Division of Pediatric Surgery Department of Surgery University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,4,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2014.01.001"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199911000-00009"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31804a5750"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348946707600402"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/753526"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-016-3943-3"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2014.626"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940511400205"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348949710601101"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2010.11.007"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2007.17"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.233"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2013.07.006"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198902000-00004"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2014.1843"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2016.01.028"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2010.05.021"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.23186"},{"issue":"7","key":"e_1_2_8_20_1","first-page":"613","article-title":"Clinical disagreement: I. How often it occurs and why. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario","volume":"123","year":"1980","journal-title":"Can Med Assoc J"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2018.05.022"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2018.05.007"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818775091"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000009850"}],"container-title":["Clinical Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcoa.13530","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.13530","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/coa.13530","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.13530","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T12:53:08Z","timestamp":1694004788000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/coa.13530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,13]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1111\/coa.13530"],"URL":"https:\/\/doi.org\/10.1111\/coa.13530","archive":["Portico"],"relation":{},"ISSN":["1749-4478","1749-4486"],"issn-type":[{"value":"1749-4478","type":"print"},{"value":"1749-4486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,13]]},"assertion":[{"value":"2019-10-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-04-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}