Development And Evaluation Of Risk Assessment Scale Of Aspiration For Adult ICU Patients

ObjectiveThe purpose of this study is to construct and evaluate the reliability and validity of the risk assessment scale of adult ICU patients’ aspiration,to further clarify the diagnostic threshold,risk level and clinical applicability of the scale,so as to help clinical medical staff to screen out the high-risk patients of ICU aspiration in the early stage,and to provide reference for the next step to take targeted and graded preventive measures to reduce the incidence of aspiration in critically ill patients.Method1.The preliminary construction of risk assessment scale for adult ICU patients’aspirationThrough literature analysis,group discussion,clinical practice and other methods,the risk factors of aspiration were separated out,and the item pool of the scale was preliminarily determined.Delphi method was used to carry out two rounds of expert correspondence in the item pool of the scale.According to the expert opinion,the items of the scale were selected and optimized,and the initial scoring standard of adult ICU patients’ aspiration risk assessment scale was constructed.2.Determination of risk assessment scale for adult ICU patients with aspiration errors and evaluation of its reliability and validity390 ICU patients admitted to ICU from January to November 2019 were prospectively investigated by using the method of convenient sampling and the initial scoring standard of adult ICU patient aspiration risk assessment scale.The items of the scale were further screened and simplified according to the differentiation analysis and frequency analysis.The weight of items was calculated by factor analysis and re-assigned the value;the ROC curve was drawn to define the diagnostic threshold of the scale,and the risk level of the quantitative scale was defined by the percentile method to form the final version of the risk assessment scale for adult ICU patients’ aspiration.The validity of the scale was evaluated by content validity,prediction validity and structure validity,and the reliability of the scale was evaluated by inter-rater reliability and internal consistency reliability.Result1.The formation of initial entry pool of ICU patients’ aspiration risk assessment scaleThrough literature analysis,group discussion and other research methods,based on clinical practice and other risk assessment tools of aspiration,19 risk factors were finally determined to form the item pool of the scale.2.Screening of scale entries2.1 Delphi expert consultation method to screen items of the scaleThe effective response rates of the two rounds of expert consultation questionnaires were 91.7%and 100%,the authority coefficients of experts were 0.89 and 0.91 respectively,and the Kendall coordination coefficients of the two rounds of consultation were 0.305 and 0.381 respectively.After two rounds of expert consultation,a total of 1 item was deleted,1 item was merged,5 items were modified,and 17 items were initially reserved.2.2 Item analysis to screen items of the scaleThe results of frequency analysis showed that the frequency of 5 items was less than 30%,and there was no significant difference in 4 items of discrimination analysis(P>0.05).Combined with group discussion,2 items of "myasthenia gravis" and "muscle relaxant" were deleted,and finally 15 items were retained.3.Determine the weight,diagnostic threshold and risk level of the scale items3.1 Weight of scale itemsAccording to kmo test,the statistics=0.588>0.5,χ2＝880.982,df=105,ballett spherical test p=0.000<0.01,the first six common factors whose characteristic value is greater than 1 are extracted,and the cumulative variance contribution rate is 61.903%.The normalized weight of each item of the scale was 0.014115-0.099824,and the order from large to small was gastroesophageal operation(0.099824),gastroesophageal reflux(0.098243),mechanical ventilation(0.086376),central nervous system disease(0.083998),sedative and analgesic(0.080732),bedside elevation angle(0.076806),vomiting(0.071165),state of consciousness(0.071006),way of eating(0.069 984),gastric remnant(0.064049),swallowing function(0.060339),abdominal pressure(0.046007),age(0.039569),antacid(0.037788),artificial airway(0.014115).Each entry is assigned a value based on the normalized value.3.2 Diagnostic threshold and risk level of scaleThe area under ROC curve was 0.928,P<0.01.When the highest value of Youden index was 0.682,the sensitivity of the scale was 86.4%,the specificity was 81.8%,and the final diagnostic threshold of the scale was 20 points.The risk level of the scale was determined by percentile method,and the risk of aspiration was divided into three levels:20-25 for low risk(level I);26-36 for medium risk(Level Ⅱ);and≥37 for high risk(levelⅢ).3.3 Through the risk assessment of 390 patients,the average score of aspiration group was 29.59 ± 7.51,significantly higher than that of non-aspiration group(14.29 ± 6.66)(P<0.001);the risk stratification results of aspiration in the two groups were statistically significant(P<0.01).4.Evaluation of reliability and validity of risk assessment scale for aspiration of ICU patientsBased on the Delphi method and item analysis method,the items of the scale were determined to ensure the content validity of the scale.The maximum load coefficient of more than 87%items in the factor analysis method was greater than 0.4,indicating that the scale had good structural validity.The area under the ROC curve of the scale was 0.928,reflecting the good predictive validity of the scale.The Cronbach a coefficient was 0.705,and the reliability coefficient between the two evaluators was 0.987.Conclusion:The item of risk assessment scale for adult ICU patients with aspiration is simple and reasonable.It has good diagnostic sensitivity,specificity,reliability and validity.The prediction efficiency is basically consistent with the results of clinical aspiration.It can be used as a screening tool for clinical assessment of risk of aspiration in ICU patients.