非人工气道老年患者痰液潴留判定标准准确性的评价

Clinical evaluation of determination criteria of sputum retention among elderly patients with non-artificial airway

目的 :对非人工气道老年患者痰液潴留的判定标准进行评定者间一致性和诊断准确性评价。方法 :评定者间一致性由两名评定者同时依据该判定标准对20名患者进行了76例次测评,计算每项指征评估结果的一致率,并进行Kappa分析;准确性评价由研究者在责任护士对患者实施助排痰措施前根据判定标准对58名患者进行了361例次的测评;参照标准为助排痰后患者排出痰液为阳性、未排出痰液为阴性,计算痰液潴留判定标准的灵敏度、特异度等。结果 :两名评定者对非人工气道老年患者痰液潴留判定标准中每项指征评估结果的一致率均大于85%,Kappa值为0.79。该判定标准的灵敏度为80.51%,特异度为91.57%,优势比为44.86,Youden指数为0.72,阳性似然比为9.55,阴性似然比为0.21,ROC曲线下面积为0.86。结论 :经初步临床评价,非人工气道老年患者痰液潴留的判定标准显示出了较好的评定者间信度和准确性,有较好的临床适用性,可以为临床工作人员判断痰液潴留提供参考。

Objective： To evaluate the inter-rater reliability and diagnostic accuracy of the determination criteria of sputum retention among elderly patients with non-artificial airway. Methods： For inter-rater reliability, twenty patients were evaluated 76 times by two researchers on the basis of the criteria simultaneously and we calculated the consistency rates of each indication and the Kappa analysis. For accuracy of the criteria, we conducted 361 evaluations among 58 patients based on the criteria, and the results of nurses assisted discharging sputm were used as reference standards. The evaluations were completed before nurses assisted patients to discharge sputum with discharging sputum positive and no sputum negative. The sensitivity, specificity and other indexes were calculated. Results： The consistency rates for each indicators between the two researchers were more than 85%, and the Kappa was 0.79. The sensitivity of the criteria for determination of sputum retention was 80.51% with the specificity 91.57%, the odds ratio 44.86, the Youden index 0.72, the positive likelihood ratio 9.55, the negative likelihood ratio was 0.21, and the area under the ROC curve 0.86. Conclusion： The initial clinical validation shows that the criteria have good inter-rater reliability and accuracy. The results of this study could facilitate clinical nurses to detect sputum retention.