• Am. J. Crit. Care · Mar 2018

    Multicenter Study

    Validation of a Postextubation Dysphagia Screening Tool for Patients After Prolonged Endotracheal Intubation.

    • Karen L Johnson, Lauri Speirs, Anne Mitchell, Heather Przybyl, Diane Anderson, Brenda Manos, Amy T Schaenzer, and Keri Winchester.
    • 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. Karen.johnson2@bannerhealth.com.
    • Am. J. Crit. Care. 2018 Mar 1; 27 (2): 89-96.

    BackgroundPatients 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.ObjectivesTo establish content validity, analyze interrater reliability, and determine sensitivity and specificity of an evidence-based postextubation dysphagia screening tool developed by a multidisciplinary team.MethodsA 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.ResultsIndividual 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%.ConclusionThe 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.©2018 American Association of Critical-Care Nurses.

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