A proposed uniform 4-point Likert scoring framework for the Functional Airway Evaluation Screening Tool-15: A scoring standardization study for pediatric sleep-disordered breathing screening

CONTEXT: The FAirEST-15 is a comprehensive 15-item clinical screening tool for pediatric sleep-disordered breathing (SDB). Although its domain structure has been previously established, the existing non-uniform scoring system-comprising both 3-point and 4-point items-limits score comparability and reduces statistical sensitivity. AIM: To standardize the FAirEST-15 by converting all clinical items into a uniform 4-point Likert scale based on graded severity. METHODS: A methodological refinement study was conducted using an expert consensus approach. Each of the 15 items was redefined to incorporate a four-level severity gradient: Grade 1 (Normal/Ideal), Grade 2 (Mild deviation), Grade 3 (Moderate deviation), and Grade 4 (Severe deviation). Content validity was reassessed following scale expansion to ensure clarity and clinical relevance. RESULTS: A standardized scoring framework was developed, yielding a total score range of 15-60. The revised structure enables the calculation of domain-specific scores and enhances the tool's ability to discriminate between varying levels of clinical risk, particularly in borderline cases. CONCLUSION: Standardization of the FAirEST-15 into a uniform 4-point Likert scale improves its psychometric robustness and clinical applicability. The refined tool facilitates more precise risk stratification for pediatric SDB in both dental and otolaryngological settings. KEY MESSAGES: Standardization of the FAirEST-15 into a uniform 4-point Likert scale improves scoring consistency, sensitivity, and clinical applicability in pediatric sleep-disordered breathing screening.