Multi-professional screening instrument for risk of broncho-aspiration in a hospital environment for the elderly population: validity evidence based on response processes

Miquilussi, Paloma Alves; Santos, Rosane Sampaio; Massi, Giselle Aparecida de Athayde

doi:10.1590/2317-1782/20232022228en

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • CoDAS 36 (1) • 2024 • https://doi.org/10.1590/2317-1782/20232022228en copy

Multi-professional screening instrument for risk of broncho-aspiration in a hospital environment for the elderly population: validity evidence based on response processes

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

The objective of this study was to validate the Multiprofessional Screening Instrument for Broncho-aspiration Risk in Hospital Environment, which is aimed at the elderly population, based on response processes.

Methods

Judges applied the instrument to different patients and randomly selected. After the application, the judges were interviewed so that it was possible to verify their impression regarding the relevance of the items about their interpretation of the written content, as well as grammatical and semantic issues. Suggestions for adding alternative questions and answers were considered, as well as proposals for adapting the questions that made up the instrument. Non-verbal reactions, such as facial expressions that suggested doubts or hesitations, by the judges concerning the instrument were also analyzed.

Results

The agreement of the judges concerning each item of the device was calculated by the Content Validity Index (CVI) and by the Intraclass Correlation Coefficient (ICC), and their results showed a high level of agreement. Through the suggestions of the judges, a new version of the Multi-professional Screening Instrument for the Risk of Broncho-aspiration in a Hospital Environment in the Elderly was elaborated.

Conclusion

The results obtained showed that the validity of the Multi-professional Instrument for Screening the Risk of Broncho-aspiration in the Hospital Environment with the elderly population, based on the response processes, was achieved and makes it a promising device to assist professionals in hospital care for the elderly.

Keywords:
Deglutition Disorder; Aged; Pneumonia Aspiration; Validation Study; Patient Care Team

Variables	n	%
Age
25 to 39 years old	12	80.0
40 years or older	3	20.0
Academic level
Postgraduate degree	12	80.0
Master’s degree	3	20.0
Practice area
Only clinical practice	6	40.0
Clinical practice and teaching	9	60.0
Length of clinical practice
Between 2 and 5 years	5	33.3
Between 5 and 10 years	3	20.0
10 years or more	7	46.7

Questions	CVI	Professionals considered the issue relevant or very relevant	Professionals considered the question to be clearly written	Professionals kept the wording of the questions without any suggestions for changes	Professionals kept the binomial yes/no answer	Professionals kept the questions with no suggested additions
Questions	CVI	n (%)	(%)	(%)	(%)	(%)
1) Patient aged ≥ 60 years?	1	15 (100)	80	73.3	93.3	100
() yes () no	1	15 (100)	80	73.3	93.3	100
2) Do you have a history of previous illnesses (neurological, respiratory, oesophageal, gastric, cx of head and neck)?	1	15 (100)	86.6	80	93.3	86.6
() yes () no	1	15 (100)	86.6	80	93.3	86.6
3) Is the patient with a GCS score of < 13?	1	15 (100)	73.3	66.6	100	93.3
() yes () no	1	15 (100)	73.3	66.6	100	93.3
4) Did you require Orotracheal Intubation?	1	15 (100)	73.3	60	86.6	86.6
() yes () no	1	15 (100)	73.3	60	86.6	86.6
5) Orotracheal intubation time ≥ 24 hours?	0.93	14 (93.3)	80	46.6	93.3	86.6
() yes () no	0.93	14 (93.3)	80	46.6	93.3	86.6
6) Do you use tracheostomy?	1	15 (100)	100	86.6	100	73.3
() yes () no	1	15 (100)	100	86.6	100	73.3
7) Does the patient experience dyspnea?	1	15 (100)	100	86.6	86.6	66.6
() yes () no	1	15 (100)	100	86.6	86.6	66.6
8) Does the patient have poor oral hygiene?	0.93	14 (93.3)	73.3	53.3	93.3	60
() yes () no	0.93	14 (93.3)	73.3	53.3	93.3	60
9) Does the patient use an alternative feeding route (NES, GTT, Jejunostomy)?	1	15 (100)	100	86.6	86.6	73.3
() yes () no	1	15 (100)	100	86.6	86.6	73.3
10) Does the patient have a cough/gasp while eating or with saliva?	1	15 (100)	100	100	93.3	66.6
() yes () no	1	15 (100)	100	100	93.3	66.6

ITEM	ICC	Confidence interval - 95%
ITEM	ICC	Lower limit	Upper limit
1	0.952	0.886	0.999
2	0.961	0.883	0.999
3	0.945	0.836	0.999
4	0.925	0.878	0.999
5	0.891	0.868	0.999
6	0.906	0.882	0.999
7	0.962	0.886	0.999
8	0.884	0.865	0.999
9	0.969	0.908	0.999
10	0.973	0.921	0.999
Total	0.931	0.900	0.996

ITEMS	Hesitation		Frowning		Tilting head		Hand to mouth
ITEMS	n	%	n	%	n	%	n	%
1	2	13.3	1	6.7	-	-	-	-
2	1	6.7	2	13.3	-	-	1	6.7
3	4	26.7	2	13.3	1	6.7	-	-
4	2	13.3	2	13.3	1	6.7	-	-
5	2	13.3	-	-	1	6.7	-	-
6	1	6.7	-	-	1	6.7	-	-
7	2	13.3	-	-	-	-	1	6.7
8	3	20.0	1	6.7	2	13.3	2	13.3
9	-	-	1	6.7	-	-	-	-
10	1	6.7	-	-	-	-	1	6.7

Questions from the first version of the Multiprofessional Screening Instrument for Bronchoaspiration Risk in the Hospital Environment	Adaptations for the second version of the Instrument
1. Is the patient ≥60 years old?	Question format removed and answers to this question adapted. Replacement of the symbol with its full spelling, as it could be noted that this would cause less confusion for individuals unfamiliar with the symbolism.
2. Do you have a history of previous illness? (Neurological, Respiratory, Oesophageal, Gastric, cx of Head and Neck)	Inclusion of the word “current”, thus comprising not only the history of previous illnesses and modification of the suggestions of illnesses to also encompass “head and neck illnesses”.
3. Is the patient with a GCS score of < 13?	Replacing the symbol by writing it in full.
4. Did you need Orotracheal Intubation?	Inclusion of the term “in this hospitalisation? “, as this scenario would have an impact on the patient's current condition.
5. Orotracheal intubation time (OIT) ≥ 24 h?	Replacement of the symbol with its full spelling. Inclusion of the term “in this hospitalisation” and inclusion of the answer option “not applicable”.
6. Do you use a tracheostomy?	No change.
7. Does the patient experience dyspnea?	Inclusion of the answer option “not applicable”, considering that only the patient can answer this question and some patients are unable to due to their clinical condition.
8. Does the patient have poor oral hygiene?	Replacement of the term inadequate with adequate.
9. Does the patient use an alternative feeding route (NES, GTT, Jejunostomy)?	Addition of the term “as the only route”, since some patients only need this route as a nutritional supplement. Inclusion of the alternative parenteral route (PN), as it is a feeding route present in the hospital environment.
10. Does the patient cough/gasp while eating or with saliva?	Inclusion of the answer option “not applicable”, considering that only the patient can answer this question and some patients are unable to due to their current clinical condition or underlying illnesses.

Items that made up the first version of the Instrument	Suggested modifications	Items considered for the second version of the instrument
1) Is the patient ≥ 60 years old? Answer: () No () Yes	Question: a) Age: (b) Is the patient older than or equal to 60 years? Answer: a) () 60-74 years, b) () over 75 years old	1) Age: () between 60 and 74 years old () over 75
2) Do you have a history of previous illnesses (neurological, respiratory, oesophageal, gastric, cx of head and neck)? Answer: () No () Yes	Question: a) History of previous illness: (Neurological, Respiratory, Oesophageal, Gastric, cx of Head and Neck). b) History of current or previous illness: (Neurological, Respiratory, Oesophageal, Gastric, cx of Head and Neck or neoplasm); c) Any history of previous illness? (Add: stroke, Parkinson's, dementia) Answer: (a) () present, () absent b) What comorbidities?	2) Do you have a history of current or previous illness (neurological, gastric, respiratory, or head and neck disease)? Answer: () No () Yes
3) Is the patient with a GCS score of < 13? Answer: () No () Yes	Question: a) Is the patient with a GCS score greater than 13? b) GCS less than 13: c) Is the patient with a GCS score less than 13? d) Is this the patient's baseline waking state?	3) Is the patient with a GCS score of less than 13? Answer: () No () Yes
4) Did you require Orotracheal Intubation (OI)? Answer: () No () Yes	Question: a) Did you require OI during this hospitalisation? b) OI: c) How many days? d) How long? e) During this hospitalisation? f) Did you stay in the ICU?	4) Did you require OI during this hospitalisation? Answer: () No () Yes
5) Orotracheal intubation time (OIT) ≥ 24 h? Answer: () No () Yes	Question: a) OIT greater than or equal to 24 h? b) OIT ≥ 24 h: c) Time of OIT ≥ 24 h, in this hospitalisation? d) How many days? e) Cause of OIT? Answer: a) () Not applicable	5) OIT greater than or equal to 24 hours in this hospitalisation? Answer: () No () Not applicable () Yes
6) Do you use a tracheostomy? Answer: () No () Yes	Question: a) Tracheostomy: b) Did you use a tracheostomy during this hospitalisation? c) Has extubation failed? d) How long have you been using it? e) Since this hospitalisation? f) Have you used it before? Answer: a) () present () absent	6) Do you use a tracheostomy? Answer: () No () Yes
7) Does the patient experience dyspnea? Answer: () No () Yes	Question: a) Dyspnea: b) Is the patient short of breath? c) Do you use O₂ support? d) At what times of the day? e) When is it most intense? f) How often? g) Was this the reason for hospitalisation? Answer: a) () not applicable	7) Does the patient feel “short of breath”? Answer: () No () Not applicable () Yes
8) Does the patient have poor oral hygiene? Answer: () No () Yes	Question: a) Does the patient have adequate oral hygiene? b) Oral hygiene: c) Does the patient have poor oral hygiene? d) Do you use dentures? e) Do you perform oral hygiene alone? f) How often do you perform oral hygiene? g) Why is oral hygiene poor? Answer: a) () Partially adequate	8) Does the patient have poor oral hygiene? Answer: () Yes () No
9) Does the patient use an alternative feeding route (NES, GTT, Jejunostomy)? Answer: () No () Yes	Question: a) Alternative feeding route: (NES, GTT, Jejunostomy) b) Does the patient use an alternative feeding route as the sole route? c) Does the patient use an alternative feeding route? (NES, GTT, Jejunostomy, PN) d) How long have you been using an alternative feeding route? e) Have you used them before? f) Why are you using the device?	9) Does the patient use a feeding tube as the only route? (NES, GTT, Jejunostomy, PN). Answer: () No () Yes
10) Does the patient have a cough/gasp while eating or with saliva? Answer: () No () Yes	Question: a) Positioning in bed: _______ b) What type of consistency does the patient eat? c) With what foods? d) How long have they been having these episodes? e) When did these symptoms start? f) How often? g) What is the cause of the coughing/sniffing? Answer: a) () not applicable	10) Does the patient cough/gasp while eating or with saliva? () No () Not applicable () Yes

Sociedade Brasileira de Fonoaudiologia Al. Jaú, 684, 7º andar, 01420-002 São Paulo - SP Brasil, Tel./Fax 55 11 - 3873-4211 - São Paulo - SP - Brazil
E-mail: revista@codas.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Conflict of interests: nothing to declare.