Session Grading

What is Session Grading?

Standardization of Spirometry 2019 Update by American Thoracic Society and European Respiratory Society is the gold standard to adhere to for any spirometry session

These technical standards have the goal of helping attain the best possible result for each subject. As the results for any spirometry session are dependent on subject cooperation, an objective reflection of the quality of the results is very important. 

The session grading system that is included in the update does not reflect the health of the lungs being measured, but instead shows the consistency of the subject's blows, meaning the degree of repeatability of the test.

Having a higher repeatability for the test increases the confidence level in the interpretation of the test results. Essentially, the grade shows the degree of confidence about the spirometry results representing the best the subject was able to do at the time, with the implication that a similar value would be reached if the test was repeated.

This repeatability criteria is used to determine if more maneuvers are needed as well. Studies have found that most adults are able to achieve FVC and FEV1 repeatability to within 0.150 L(2,3) and that children are able to achieve repeatability within 0.150 or 0.100 L(4).

2022-03 SpiroClinic Pro Results Page Session grading-1

Session grading system for FEVand FVC

The grading system is used for FEV1 and FVC separately and is applied to the differences between the two largest values of both

Grade A means that there are 3 or more acceptable measurements, with a repeatability of within 0.150 L for subjects older than 6 years old and within 0.100 L for subjects 6 years old or younger (or 10% of the highest value).

Grade B means that there are 2 acceptable measurements, with a repeatability of within 0.150 L for subjects older than 6 years old and within 0.100 L for subjects 6 years old or younger (or 10% of the highest value).

Grade C means that there are 2 or more acceptable measurements, with a repeatability of within 0.200 L for subjects older than 6 years old and within 0.150 L for subjects 6 years old or younger (or 10% of the highest value).

Grade D means that there are 2 or more acceptable measurements, with a repeatability of within 0.250 L for subjects older than 6 years old and within 0.200 L for subjects 6 years old or younger (or 10% of the highest value).

Grade E means that there are 2 or more acceptable measurements or 1 acceptable measurement, with a repeatability within more than 0.250 L for subjects older than 6 years old and more than 0.200 L for subjects 6 years old or younger (or 10% of the highest value).

Grade U means that there are no acceptable measurements, and 1 or more usable measurements.

Grade F means there are no acceptable and/or usable measurements.

Some maneuvers may be acceptable or usable at grading levels lower than A, but the overriding goal for the operator should be to achieve the best possible test quality for every subject

Sources

  1. "Standardization of Spirometry 2019 Update". An Official American Thoracic Society and European Respiratory Society Technical Statement, 2019.
  2. "Quality of spirometry tests performed by 9893 adults in 14 countries: the BOLD Study". Respiratory Medicine, 2011.
  3. "Repeatability of spirometry in 18,000 adult patients". American Journal of Respiratory and Critical Care Medicine, 2004.
  4. "Quality of spirometry in 5-to-8-year-old children". Pediatric Pulmonology, 2013.

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