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Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial.
J Child Neurol. 2023 02; 38(1-2):44-51.JC

Abstract

BACKGROUND

There is limited evidence on the use of facial nerve function grading scales in acute facial nerve paralysis in children.

OBJECTIVE

To investigate the agreement between and the usability of the House-Brackmann and Sunnybrook scales in children with idiopathic facial paralysis (Bell's palsy) and to compare their ease of administration.

METHODS

Data from a randomized controlled trial in children aged 6 months to <18 years with Bell's palsy was used. Children were recruited within 72 hours of symptom onset and assessed using the House-Brackmann and the Sunnybrook scales at baseline and at 1, 3, and 6 months until recovered. Agreement between the scales was assessed using the intraclass correlation coefficient (ICC) at each time point and using a Bland-Altman plot. Ease of administration was assessed using an 11-point Likert scale.

RESULTS

Comparative data were available for 169 of the 187 children randomized. The ICC between the 2 scales across all time points was 0.92 (95% confidence interval [CI] 0.91-0.93), at baseline 0.37 (95% 0.25, 0.51), at 1 month 0.91 (95% CI 0.89-0.94), at 3 months 0.85 (95% CI 0.80-0.89), and at 6 months 0.96 (95% CI 0.95-0.97). The median score for the ease of administration for the House-Brackmann and Sunnybrook scales was 3 (interquartile range [IQR]: 1-5) and 7 (IQR: 4-8) respectively (P < .001, Wilcoxon signed-rank test).

CONCLUSIONS

There was excellent agreement between House-Brackmann and Sunnybrook scales, with poorer agreement at baseline. Clinicians found the House-Brackmann scale easier to administer. These findings suggest that both scales can be applied in children.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Williams A
Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia. Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Eapen N
Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia. Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
Kochar A
Emergency Department, Women's and Children's Hospital, Adelaide, Australia.
Lawton B
Emergency Department, 4607Logan Hospital, Brisbane, Queensland, Australia.
Hort J
Emergency Department, 8538The Children's Hospital at Westmead, Sydney, Australia.
West A
Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia.
George S
Department of Emergency Medicine, Gold Coast University Hospital, Southport, Australia. School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Australia.
Berkowitz R
Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia. Department of Otolaryngology, Royal Children's Hospital, Parkville, Victoria, Australia.
Lee KJ
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia. Clinical Epidemiology and Biostatistics Unit, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Dalziel SR
Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand. Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
Hearps S
Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Babl FE
Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia. Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia. Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network
No affiliation info available

MeSH

HumansChildBell PalsyFacial NerveTreatment OutcomeFacial Paralysis

Pub Type(s)

Randomized Controlled Trial
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

36740927

Citation

Williams, Amanda, et al. "Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial." Journal of Child Neurology, vol. 38, no. 1-2, 2023, pp. 44-51.
Williams A, Eapen N, Kochar A, et al. Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial. J Child Neurol. 2023;38(1-2):44-51.
Williams, A., Eapen, N., Kochar, A., Lawton, B., Hort, J., West, A., George, S., Berkowitz, R., Lee, K. J., Dalziel, S. R., Hearps, S., & Babl, F. E. (2023). Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial. Journal of Child Neurology, 38(1-2), 44-51. https://doi.org/10.1177/08830738221144082
Williams A, et al. Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial. J Child Neurol. 2023;38(1-2):44-51. PubMed PMID: 36740927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial. AU - Williams,Amanda, AU - Eapen,Nitaa, AU - Kochar,Amit, AU - Lawton,Ben, AU - Hort,Jason, AU - West,Adam, AU - George,Shane, AU - Berkowitz,Robert, AU - Lee,Katherine J, AU - Dalziel,Stuart R, AU - Hearps,Stephen, AU - Babl,Franz E, AU - ,, Y1 - 2023/02/05/ PY - 2023/3/30/medline PY - 2023/2/7/pubmed PY - 2023/2/6/entrez KW - Bell's palsy KW - House-Brackmann scale KW - Sunnybrook scale KW - child SP - 44 EP - 51 JF - Journal of child neurology JO - J Child Neurol VL - 38 IS - 1-2 N2 - BACKGROUND: There is limited evidence on the use of facial nerve function grading scales in acute facial nerve paralysis in children. OBJECTIVE: To investigate the agreement between and the usability of the House-Brackmann and Sunnybrook scales in children with idiopathic facial paralysis (Bell's palsy) and to compare their ease of administration. METHODS: Data from a randomized controlled trial in children aged 6 months to <18 years with Bell's palsy was used. Children were recruited within 72 hours of symptom onset and assessed using the House-Brackmann and the Sunnybrook scales at baseline and at 1, 3, and 6 months until recovered. Agreement between the scales was assessed using the intraclass correlation coefficient (ICC) at each time point and using a Bland-Altman plot. Ease of administration was assessed using an 11-point Likert scale. RESULTS: Comparative data were available for 169 of the 187 children randomized. The ICC between the 2 scales across all time points was 0.92 (95% confidence interval [CI] 0.91-0.93), at baseline 0.37 (95% 0.25, 0.51), at 1 month 0.91 (95% CI 0.89-0.94), at 3 months 0.85 (95% CI 0.80-0.89), and at 6 months 0.96 (95% CI 0.95-0.97). The median score for the ease of administration for the House-Brackmann and Sunnybrook scales was 3 (interquartile range [IQR]: 1-5) and 7 (IQR: 4-8) respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS: There was excellent agreement between House-Brackmann and Sunnybrook scales, with poorer agreement at baseline. Clinicians found the House-Brackmann scale easier to administer. These findings suggest that both scales can be applied in children. SN - 1708-8283 UR - https://www.unboundmedicine.com/medline/citation/36740927/Agreement_Between_House_Brackmann_and_Sunnybrook_Facial_Nerve_Grading_Systems_in_Bell's_Palsy_in_Children:_Secondary_Analysis_of_a_Randomized_Placebo_Controlled_Multicenter_Trial_ DB - PRIME DP - Unbound Medicine ER -