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权衡南非吞咽障碍分诊的利弊。

Weighing up the pros and cons of dysphagia triage in South Africa.

机构信息

Department of Speech Pathology, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg.

出版信息

S Afr J Commun Disord. 2023 Feb 21;70(1):e1-e10. doi: 10.4102/sajcd.v70i1.941.

Abstract

BACKGROUND

Early identification of dysphagia followed by intervention reduces, length of hospitalisation, degree of morbidity, hospital costs and risk of aspiration pneumonia. The emergency department offers an opportune space for triage. Triaging offers risk-based evaluation and early identification of dysphagia risk. A dysphagia triage protocol is not available in South Africa (SA). The current study aimed to address this gap.

OBJECTIVES

To establish the reliability and validity of a researcher-developed dysphagia triage checklist.

METHOD

A quantitative design was used. Sixteen doctors were recruited from a medical emergency unit at a public sector hospital in SA using non-probability sampling. Non-parametric statistics and correlation coefficients were used to determine the reliability, sensitivity and specificity of the checklist.

RESULTS

Poor reliability, high sensitivity and poor specificity of the developed dysphagia triage checklist was found. Importantly, the checklist was adequate in identifying patients as not being at risk for dysphagia. Completion time for dysphagia triage was 3 minutes.

CONCLUSION

The checklist was highly sensitive but not reliable or valid for use in identifying patients at risk for dysphagia.Contribution: The study provides a platform for further research and modification of the newly developed triage checklist, which is not recommended for use in its current form. The merits of dysphagia triage cannot be ignored. Once a valid and reliable tool is confirmed, the feasibility of implementation of dysphagia triage must be considered. Evidence to confirm that dysphagia triage can be conducted, when considering the contextual, economic, technical and logistic aspects of the context, is necessary.

摘要

背景

早期识别吞咽困难并进行干预可减少住院时间、发病率、住院费用和吸入性肺炎的风险。急诊科为分诊提供了一个机会。分诊提供基于风险的评估和早期识别吞咽困难风险。南非(SA)没有吞咽困难分诊协议。本研究旨在解决这一差距。

目的

建立研究者开发的吞咽困难分诊清单的可靠性和有效性。

方法

采用定量设计。使用非概率抽样从 SA 一家公立医院的医疗急救单位招募了 16 名医生。使用非参数统计和相关系数来确定清单的可靠性、灵敏度和特异性。

结果

发现开发的吞咽困难分诊清单的可靠性差、灵敏度高、特异性差。重要的是,该清单足以确定患者没有吞咽困难的风险。吞咽困难分诊的完成时间为 3 分钟。

结论

该清单对识别有吞咽困难风险的患者高度敏感,但不可靠或有效。

贡献

该研究为进一步研究和修改新开发的分诊清单提供了一个平台,不建议以其当前形式使用。不能忽视吞咽困难分诊的优点。一旦确认了有效和可靠的工具,就必须考虑实施吞咽困难分诊的可行性。有必要确认在考虑上下文、经济、技术和后勤方面的情况下,可以进行吞咽困难分诊的证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d02c/9982486/abd5059ef301/SAJCD-70-941-g001.jpg

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