This work was funded by Uppsala University and the Acta Otolaryngologica Foundation. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Prediction of nonrecovery in Bell's palsy using sunnybrook grading†
Article first published online: 28 FEB 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 4, pages 901–906, April 2012
How to Cite
Marsk, E., Bylund, N., Jonsson, L., Hammarstedt, L., Engström, M., Hadziosmanovic, N., Berg, T. and Hultcrantz, M. (2012), Prediction of nonrecovery in Bell's palsy using sunnybrook grading. The Laryngoscope, 122: 901–906. doi: 10.1002/lary.23210
- Issue published online: 20 MAR 2012
- Article first published online: 28 FEB 2012
- Manuscript Accepted: 29 DEC 2011
- Manuscript Revised: 22 DEC 2011
- Manuscript Received: 15 NOV 2011
- Facial palsy;
- facial paralysis;
- facial nerve;
- multivariate analysis;
- receiver operating characteristics;
- area under the curve;
- Level of Evidence: 1b
To develop a clinical prognostic model to identify Bell's palsy patients with risk for nonrecovery at 12 months.
Data from a prospective, randomized, double-blind, placebo-controlled, multicenter study.
There were 829 patients with Bell's palsy randomized in a factorial fashion to treatment with prednisolone or no prednisolone. Facial function was assessed with the Sunnybrook grading scale. Univariate and multivariate logistic regression analyses at different time points were used to identify factors predicting nonrecovery, defined as Sunnybrook <70 at 12 months. Variables studied were age, gender, time to inclusion, prednisolone treatment, side of palsy, pain at inclusion, and Sunnybrook scores. Factors of predictable significance were used to construct prognostic models at baseline, days 11 to 17, and at 1 month. Receiver operating characteristics curves were created to test the predictive capacity of the models.
At baseline, treatment with prednisolone or no prednisolone (P = .0005), age (P = .04) and the Sunnybrook score (P = .0002) were significant factors for predicting nonrecovery. The receiver operating characteristics area under the curve at baseline for these three variables was 0.74 (sensitivity 0.83, specificity 0.57). At days 11 to 17 and at 1 month, the Sunnybrook score was the only significant predictive variable. The respective areas under the curves for the Sunnybrook score at these time points were 0.83 (sensitivity 0.81, specificity 0.75) and 0.94 (sensitivity 0.91, specificity 0.85).
Sunnybrook grading at 1 month most accurately predicts nonrecovery at 12 months in Bell's palsy. Laryngoscope, 2012