Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Michael S. Weinstock

Abstract

The Clinical Assessment Score-15 (CAS-15) is an office-based tool for assessing the riskof sleep disordered breathing (SDB), a relatively common condition in the pediatric population. Change in CAS-15 following total tonsillectomy (TT) has been shown to have a large effect size, but it is unclear how it varies following partial intracapsular tonsillectomy (PIT). Thus, the objective of the present study is to evaluate the utility of the CAS-15 score in assessing the effectiveness of PIT and how this compares to change after TT. Children ages 2-18 undergoing PIT (N=16) or TT (N=8) with or without adenoidectomy for SDB completed the CAS-15 before surgery and at their postoperative follow-up visit. Participants undergoing PIT did not differ significantly than those undergoing TT with regard to age, sex, BMI percentile, pre-op CAS-15 score or tonsil size, or admission rates following surgery (p>0.05). The median follow-up after surgery was 5.2 (PIT) and 4.4 (TT) weeks. CAS-15 score improved significantly following PIT (42.8±12.3 vs. 9.4±5.6, p<0.0001) and TT (45.5±13.3 vs. 7.9±5.8, p<0.0002). The decrease in CAS-15 for PIT did not differ from TT (33.3±11.8 vs. 37.6±15.0, p>0.49). CAS- 15 decreases drastically following PIT and TT, indicating significant improvement of SDB symptoms. Because the change in CAS-15 after PIT was similar to TT, PIT may be preferred due to the decreased morbidity of the procedure. Given the cost, time required, inconvenience, and other limitations of overnight polysomnography (PSG), which is the gold standard method of diagnosing SDB, CAS-15 may be a suitable replacement or adjunct for the assessment of SDB following PIT in addition to TT.

Comments

This is an Open Access Thesis.

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