Karen L. Johnson is research director, nursing, Banner Health, Phoenix, Arizona. Lauri Speirs is stroke clinical nurse specialist, JPS Health Network, Fort Worth, Texas. Anne Mitchell is a clinical nurse specialist, retired from Banner Baywood Medical Center, Mesa, Arizona. Heather Przybyl is a clinical education specialist; medical/surgical intensive care unit, Banner University Medical Center-Phoenix, Phoenix, Arizona. Diane Anderson is a speech language pathologist and rehabilitation services senior manager, Banner Baywood Medical Center. Brenda Manos is senior clinical manager cardiac care unit/intensive care unit, Banner Estrella Medical Center, Phoenix, Arizona. Amy T. Schaenzer is a speech language pathologist, Banner University Medical Center-Phoenix. Keri Winchester is a speech language pathologist, Banner Gateway Medical Center, Gilbert, Arizona.
Am J Crit Care. 2018 Mar;27(2):89-96. doi: 10.4037/ajcc2018483.
Patients who receive prolonged endotracheal intubation (> 48 hours) are at risk for dysphagia. Nurses should conduct swallowing assessments after extubation because of the high likelihood of aspiration pneumonia developing. No valid and reliable postextubation dysphagia screening tools are available.
To establish content validity, analyze interrater reliability, and determine sensitivity and specificity of an evidence-based postextubation dysphagia screening tool developed by a multidisciplinary team.
A prospective nonexperimental study was conducted in 4 medical-surgical intensive care units in 4 hospitals. The study was conducted in 3 phases: (1) establishing content validity with clinical experts who participated in a Delphi survey, (2) establishing inter-rater reliability by agreement with nurses who simultaneously and independently completed the tool, and (3) establishing sensitivity and specificity with speech language pathologists and nurses who independently and blindly completed the tool for eligible patients.
Individual item scores were > 0.82 and the overall content validity index was 0.93, indicating content validity. Interrater reliability was established (Cohen κ = 0.92). In 66 eligible patients, the prevalence of postextubation dysphagia was 56%, sensitivity of the postextubation dysphagia screening tool was 81%, and specificity was 69%.
The reliability and validity of a postextubation dysphagia screening tool that can help nurses determine an extubated patient's ability to swallow after prolonged endotracheal intubation were established.
接受长时间气管插管（>48 小时）的患者存在吞咽困难的风险。由于发生吸入性肺炎的可能性很高，护士应在拔管后进行吞咽评估。目前尚无有效的、可靠的拔管后吞咽困难筛查工具。
由多学科团队开发的一种基于证据的拔管后吞咽困难筛查工具，旨在建立其内容效度、分析组内信度，并确定其敏感性和特异性。
在 4 家医院的 4 个普通外科重症监护病房进行了一项前瞻性非实验研究。该研究分 3 个阶段进行：（1）通过参与德尔菲调查的临床专家建立内容效度；（2）通过同时且独立完成该工具的护士达成一致来建立组内信度；（3）通过独立且盲法完成该工具的言语病理学家和护士来建立敏感性和特异性。
各单项得分均>0.82，且总体内容效度指数为 0.93，表明具有内容效度。建立了组内信度（Cohen κ=0.92）。在 66 名符合条件的患者中，拔管后吞咽困难的患病率为 56%，拔管后吞咽困难筛查工具的敏感性为 81%，特异性为 69%。
建立了一种可帮助护士确定长时间气管插管后拔管患者吞咽能力的拔管后吞咽困难筛查工具的可靠性和有效性。
