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Published on: June 29, 2019
Content Validity Testing of a Nurse-Led Pediatric Dysphagia Screening Tool for Acute and Critical Care Settings Using
Christie Grunke1,2, Elizabeth C Ward1,3, Anna Miles4
1School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia.
Insights
A new screening tool, the Children's Oral Feeding Screener (COFS), was developed for hospitalized children with oropharyngeal dysphagia. Content validity was established through an eDelphi study involving international speech pathologists.
Area of Science:
- Pediatric healthcare
- Clinical assessment tools
- Swallowing disorders
Background:
- Pediatric oropharyngeal dysphagia screening tools are lacking in acute/critical care.
- Existing tools lack psychometric validation and reliability.
- This gap impacts timely diagnosis and intervention for hospitalized children.
Purpose of the Study:
- Establish content validity for the Children's Oral Feeding Screener (COFS).
- Develop a novel, nurse-led screening tool for pediatric acute and critical care settings.
- Address the need for reliable dysphagia screening in hospitalized children aged 0-16 years.
Main Methods:
- Two-round eDelphi study using Qualtrics.
- Multidisciplinary steering group guided tool development and consensus.
- International speech pathologists (n=50, 41 in R2) rated items on clinical presentations, oral trials, and dysphagia signs.
Main Results:
- Content validity achieved for COFS items based on >75% consensus.
- Final COFS includes 8 clinical presentations, 3 oral trial elements, and 14 dysphagia signs.
- Panelist feedback refined COFS headings and layout.
Conclusions:
- Content validity established for the COFS tool's core components.
- Further research needed on COFS construct validity, sensitivity, specificity, and feasibility.
- COFS has potential to improve dysphagia screening in pediatric acute/critical care.
Abstract:
Background: Pediatric oropharyngeal dysphagia screening protocols remain limited in acute and critical care settings due to the lack of psychometrically valid and reliable tools. Objectives: The eDelphi methodology was employed to establish content validity for the Children's Oral Feeding Screener (COFS), a novel, nurse-led oropharyngeal dysphagia screening tool for hospitalized children in acute and critical care (0-16 years). Methods: The two-round eDelphi study was completed using Qualtrics®. A multidisciplinary, international steering-group guided tool conceptualization, elements for rating in the eDelphi, and oversaw consensus decisions. Experienced speech pathologists in pediatric acute and/or critical care were invited as panelists and rated tool content regarding (a) clinical presentations requiring immediate referral for dysphagia assessment; (b) oral trial component/s; and (c) signs observed during oral trials suggesting dysphagia. Items were rated on a 10-point Likert scale, and panelists could give open-ended feedback. Items not reaching pre-defined consensus (>75%) were re-presented in round two. Results: Fifty panelists participated in round one and 41 in round two, primarily from Australia (n = 19; 46%) and the United Kingdom (n = 13; 34%). Half (n = 22; 54%) had >10 years' experience. Based on consensus scores, panelists' qualitative feedback, and steering group decision, final items included eight clinical presentations, three oral trial elements (cup, bottle, breastfeeding) with three associated oral trial protocols, and fourteen signs suggestive of dysphagia. Other feedback led to changes to headings and the format of the COFS layout. Conclusions: Content validity for items in the three components of the COFS was established. Further work is now required to explore other psychometric properties (construct validity, sensitivity/specificity, and feasibility) in clinical settings.
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