Localization And Evaluation Of Reliability And Validity Of GuSS-ICU Bedside Swallowing Screening Tool

Research purpose:Introduce and localize GuSS-ICU bedside swallowing screening tool,compare the reliability,validity and predictive ability of the Chinese version of GuSS-ICU bedside swallowing screening tool and the Standardized Swallowing Assessment(SSA)in Post-extubation Swallowing Dysfunction(PSD)assessment for patients after ICU long-term endotracheal intubation,with a view to introducing a simpler,safer and more predictable PSD bedside swallowing assessment tool for clinical use.Research Methods:Obtained the authorization of translating the GuSS-ICU bedside swallowing screening tool by Professor Martin Christensen via email.Introduced and localized GuSS-ICU bedside swallowing screening tool and adapted according to Chinese culture.The Chinese version of GuSS-ICU bedside swallowing screening tool was conformed finally after preliminary experiment.200 patients(in compliance with the inclusion and exclusion criteria)who admitted ICU or EICU of the First Affiliated Hospital for intubation from December 2018 to January 2020 were selected trough convenience sampling method.According to the design of the study,the specific researchers applied the Chinese version of the GuSS-ICU bedside swallowing screening tool and Standardized Swallowing Assessment(SSA)to the study subjects to independently evaluate their swallowing function at the corresponding time,the radiology staff performed Videofloroscopic Swallowing Study(VFSS)for patients after that.The reliability of the two scales was analyzed by the inter-observer consistency,and the validity was analyzed by the content validity,and criterion-related validity.With VFSS as the gold standard,the sensitivity and specificity,etc.of the two scales were calculated to test the predictive ability of the two scales.Research Results:The Chinese version of GuSS-ICU bedside swallowing screening tool had an inter-observer kappa value of 0.890(p<0.001),the content validity index(I-CVI)of the scale entry level was 0.80~1.00,and the mean S-CVI was 0.97,The kappa value was 0.7194(p<0.001)consistent with the gold standard VFSS diagnosis.The inter-observer kappa value of Standardized Swallowing Assessment(SSA)was 0.860(p<0.001),the content validity index(I-CVI)of the scale entry level was 0.80~1.00,and the mean S-CVI was 0.97,the consistency of SSA and the gold standard VFSS diagnosis results had a kappa value of 0.5976(p<0.001).The Chinese version of GuSS-ICU bedside swallowing screening tool has higher sensitivity and specificity than SSA(88.52%,80.33%;87.05,82.73%),and the evaluation time of the two groups has statistical differences(Z =-3.65,p<0.001).Research Conclusion:The Chinese version of GuSS-ICU bedside swallowing screening tool has good reliability and validity.Sensitivity,specificity,etc.all meet the requirements of scale measurement,indicating that it can accurately assess the post-extubation swallowing dysfunction(PSD)after long-term intubation.The Standardized Swallowing Assessment(SSA)has been tested by reliability and validity,which proves that it also has good inter-observer reliability and content validity.The sensitivity and specificity also basically meet the measurement requirements,but the consistency of SSA and the gold standard VFSS diagnosis results and the result of AUC area under the ROC curve all show that the accuracy of SSA to predict PSD is medium.Therefore,the Chinese version of the GuSS-ICU bedside swallowing screening tool and SSA can be used to evaluate PSD for ICU patients after long-term intubation,but the Chinese version of GuSS-ICU bedside swallowing screening tool has a higher criterion-related validity,sensitivity,specificity,and predictive ability for PSD,and is simpler and more time-saving,so it is more suitable and convenient for nursing staff to perform bedside swallowing assessment for ICU patients after long-term intubation.