Rating Surgical Field Quality in Endoscopic Ear Surgery: Proposal and Validation of the Modena Bleeding Score

By June 7, 2019

Alicandri-Ciufelli, Matteo1,2; Pingani, Luca3; Mariano, Davide1; Anschuetz, Lukas4; Molinari,Giulia1; Fermi, Matteo1; Marchioni, Daniele5; Bonali, Marco1; Galeazzi,Gian Maria6; Presutti,Livio1
1 Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy;
2 Neurosurgery Department, New Civil Hospital Sant’Agostino-Estense, Baggiovara (MO), Italy;
3 Human Resources, Department of Mental Health, Local Health Agency Reggio Emilia, Reggio Emilia, Italy;
4 Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland;
5 Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy;
6 Psychiatry Department, University of Modena and Reggio Emilia, Modena, Italy.

To develop and validate a bleeding score that could be applied in endoscopic ear surgery (EEarS).

– Study Design: prospective validation study
– Setting: tertiary referral center
– Patients: no patients included
– Intervention(s):  A new bleeding score, called “Modena Bleeding Score” (MBS), was created by the authors. It provides ve grades for rating the surgical eld during EEarS procedures (from grade 1—no bleed- ing to grade 5—bleeding that prevents every surgical procedure except those dedicated to bleeding control). A preliminary “face validity” was performed by 18 ENT specialists to assess possible misunderstandings in interpreting the scale. Then, 15 videos of endoscopic ear surgery procedures, each divided into three parts (t0, t1, and t2), were subsequently evaluated by 15 specialists, using MBS. The videos were randomly selected and assigned.

– Main Outcome Measure(s): Intra-rater reliability and inter-rater reliability were calculated. The clinical validity of the instrument was calculated using a referent standard
– Results: The face validity showed a good consensus about the clarity and comprehension of the scale; both intra and inter- rater reliability demonstrated good performance (intra-rater reliability ranged from 0.741 to 0.991 and inter-rater reliability was 0.790); clinical validity also showed positive values, ranging from 0.75 to 0.93.
– Conclusion: MBS has proved to be an e ective method to rate surgical eld during EEarS, with good-to-excellent perfor- mances. Its use would possibly help comparisons of groups in clinical trials or comparisons between studies.