Federal University of Ceará, Espenanto, Fortaleza-Ceará, Brazil.
J Clin Nurs. 2009 Mar;18(5):729-36.
To analyse the sensitivity and specificity of clinical indicators of ineffective airway clearance in children with congenital heart disease and to identify the indicators that have high predictive power.
The precise establishment of nursing diagnoses has been found to be one of the factors contributing to higher quality of care and cost reduction in healthcare institutions. The use of indicators to diagnose ineffective airway clearance could improve care of children with congenital heart disease. Design. Longitudinal study.
Participants consisted of 45 children, <or=1 year of age, with congenital heart disease, who had not had definitive or palliative surgical correction. Six assessments were made at 2-day intervals. Each clinical indicator was defined based on previously established operational criteria. Sensitivity, specificity and positive and negative predictive values of each indicator were calculated based on a model for the longitudinal data.
A nursing diagnosis of ineffective airway clearance was made in 31% of patients on the first assessment, rising to 71% on the last assessment, for a 40% increase. Sensitivity was highest for Changes in Respiratory Rates/Rhythms (0.99), followed by Adventitious Breath Sounds (0.97), Sputum Production (0.85) and Restlessness (0.53). Specificity was higher for Sputum Production (0.92), followed by Restlessness (0.73), Adventitious Breath Sounds (0.70) and Changes in Respiratory Rates/Rhythms (0.17). The best positive predictive values occurred for Sputum Production (0.93) and Adventitious Breath Sounds (0.80).
Adventitious Breath Sounds followed by Sputum Production were the indicators that had the best overall sensitivity and specificity as well as the highest positive predictive values.
The use of simple indicators in nursing diagnoses can improve identification of ineffective airway clearance in children with congenital heart disease, thus leading to early treatment of the problem and better care for these children.
分析先天性心脏病儿童无效气道清除的临床指标的灵敏度和特异性，并确定具有高预测能力的指标。
已发现，准确确定护理诊断是提高医疗机构护理质量和降低成本的因素之一。使用指标来诊断无效气道清除可改善先天性心脏病儿童的护理。设计。纵向研究。
参与者包括 45 名年龄<或=1 岁的患有先天性心脏病且尚未进行确定性或姑息性手术矫正的儿童。每 2 天评估 6 次。根据先前建立的操作标准，为每个临床指标定义。根据纵向数据模型计算每个指标的灵敏度、特异性和阳性及阴性预测值。
首次评估时，31%的患者被诊断为无效气道清除，最后一次评估时上升至 71%，增加了 40%。呼吸频率/节律改变的灵敏度最高（0.99），其次是异常呼吸音（0.97）、痰生成（0.85）和烦躁不安（0.53）。痰生成的特异性最高（0.92），其次是烦躁不安（0.73）、异常呼吸音（0.70）和呼吸频率/节律改变（0.17）。痰生成（0.93）和异常呼吸音（0.80）的阳性预测值最好。
异常呼吸音后是痰生成，作为指标具有最佳的总体灵敏度和特异性以及最高的阳性预测值。
在护理诊断中使用简单的指标可以提高对先天性心脏病儿童无效气道清除的识别，从而可以及早治疗该问题并为这些儿童提供更好的护理。
