Evaluation of the use of the modified Huddart Bodenham & EUROCRAN yardstick for the assessment of surgical outcome for unilateral cleft lip and palate
Background: The measurement of maxillary arch constriction in patients born with cleft lip and /or palate for assessment of treatment outcome is a well accepted concept. In order to improve surgical outcome, it is essential to have a valid and reliable tool to assess results. Ongoing, international, multi-centre, randomised clinical trials are likely to produce subtle, but significant results between different surgical techniques, timings and surgeons. Therefore, it is essential to compare emerging indices to assess which best fits the requirements set by the World Health Organisation.Objectives: The aim of this study was to compare the reproducibility of two indices: modified Huddart Bodenham (mHB) and EUROCRAN Yardstick .Design: Retrospective, case-control study of study models of 5-year-old patients with unilateral cleft lip and palate.Method : Thirty study models were scored using mHB and EUROCRAN Yardstick by six examiners on two occasions at least one month apart.Results: The intra- and inter-examiner intraclass correlation reproducibility with mHB indicated good reproducibility (range 0.75 to 0.94). The Bland & Altman graphs confirmed this and did not show any areas of systematic bias. The intra- and inter-examiner reproducibility using kappa statistics for EUROCRAN yardstick indicated wide variability (range 0.33 to 0.95) for maxillary arch constriction. The intra- and inter-examiner reproducibility using kappa statistics for EUROCRAN Yardstick indicated poor reproducibility (range -0/06 to 0.50) for palatal scores. The best score of 0.94 with mHB was 0.80 at the second reading and the best score of 0.95 with EUROCRAN Yardstick was 0.41 at the second reading.Conclusion: This study has revealed that mHB is more reliable than EUROCRAN Yardstick. It is superior in terms of user friendliness and time taken to learn to use the index. However, the study showed that it takes longer to score the study models using mHB than EUROCRAN Yardstick, but this improves at second exposure
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