RESUMO
To compare inter-rater, intra-rater and inter-system reliability of modified House-Brackmann and Sunnybrook grading systems. The study was conducted in a tertiary care hospital with a single cohort of 20 patients and 3 raters. The patients, eligible to be included for the study, were those over 18 years of age planned for nerve sparing parotidectomy. In the postoperative period, patients were video recorded performing specific movements according to the requirements of modified House-Brackmann and Sunnybrook systems. These recordings were used for the grading once recruitment was completed. The inter-rater, intra-rater and inter-system reliability of modified House-Brackmann and Sunnybrook systems were assessed using the intraclass coefficient. The intra-rater reliability was good-to-excellent for both groups with Intra-Class coefficient (ICC) ranging from 0.902 to 0.958 in modified House-Brackmann and in 0.802 to 0.957 Sunnybrook system. The inter-rater reliability was good-to-excellent with ICC ranging from 0.806 to 0.906 in modified House-Brackmann and 0.766 to 0.860 in Sunnybrook system. The inter-system reliability was good-to-excellent with ICC ranging from 0.892 to 0.937. There was no significant difference in the reliability of modified House-Brackmann and Sunnybrook systems. Thus, an interval scale accomplishes the task of grading facial nerve palsy in a reliable way, and the choice of the specific instrument will be based on other factors like expertise involved, ease of administration and generalisability to the incumbent clinical scenario.
RESUMO
BACKGROUND: Globally, 5.82 million deaths occurred among children under the age of five years in 2015 and injury specific mortality rate was 73 per 100,000 population. In India, injury specific mortality rate is around 2.1 per 1000 live births contributing to 4% of the total under 5 mortality rate. This study aims to estimate the burden and understand factors associated with unintentional injuries among children aged 1-5 years residing in urban slums of Vellore, southern India. We also attempted to assess the hazards posed by the living environment of these children and study their association with unintentional injury patterns. METHODS: This cross-sectional study was conducted in eight urban slums of Vellore, southern India and primary caregivers of children aged 1-5 years were interviewed with a questionnaire to obtain the details of injuries sustained in the past three months. Environmental hazard risk assessment was conducted at places frequented by these children and their scores calculated. Baseline prevalence and incidence rates of unintentional injuries were estimated. Multivariate logistic regression and poisson regression analysis were performed to examine factors associated with unintentional injuries and repeated injuries respectively. Association between environmental hazard risk and unintentional injuries was estimated. RESULTS: Prevalence of unintentional injuries was 39.1% (95% CI 35.4-42.9%) and incidence rate was 16.5 (95% CI 14.7-18.3) per 100 child months (N = 662). Bivariate analysis revealed that children of working mothers (OR 1.48; 1.01-2.18) and children from overcrowded families (OR 1.78; 1.22-2.60) had increased odds of sustaining unintentional injuries. Multivariate regression analysis revealed that children from overcrowded families had increased odds of sustaining unintentional injuries (AOR 1.66, 95% CI 1.14-2.41). Boys (IRR 1.33, 95% CI 1.07-1.66) and children from overcrowded families (IRR 1.50; 1.14-1.98) were at increased risk of having repeated injuries. There is an increase in incidence rate of injuries with an increased environmental hazard risk, although not statistically significant. CONCLUSIONS: The burden of unintentional injuries was very high among study children when compared to studies in other urban slums in India. Environment plays an important role in the epidemiology of unintentional injuries; providing safe play environment and adequate supervision of children is important to reduce its burden.
