Acurácia dos indicadores clínicos do diagnóstico de enfermagem deglutição prejudicada em crianças com disfunções neurológicas

Abstract

The objective of this study was to analyze the accuracy of the clinical indicators of nursing diagnosis Impaired swallowing (00103) in children with chronic non-progressive Encephalopathy or Microcephaly. Diagnostic accuracy study, with a cross - sectional design, performed in a nucleus of treatment and early stimulation in the city of Fortaleza (CE). Inclusion criteria were to present a medical diagnosis of non-progressive chronic encephalopathy or Microcephaly, to perform ambulatory follow-up in the service, to be aged between one year and 12 years incomplete. Children were excluded from enteral feeding; presence of cleft lip and palate. We used an instrument developed for the collection of data, containing sociodemographic and clinical variables of the children; and clinical indicators directly or indirectly related to food supply, based on the clinical indicators of the NANDA-I taxonomy for the study diagnosis. To determine the presence or absence of clinical indicators of Impaired Deglutition, we used previously validated conceptual and operational definitions. Statistical analysis was performed with SPSS® version 21.0 for Windows® and software R version 2.12.1. To verify the measures of diagnostic accuracy (sensitivity and specificity) of each indicator, the latent class analysis method was used from adjusted models. Eighty-two children were evaluated. The majority were male (62.2%), with a median of 3.45 years, of non-white color (56.1%), resident in Fortaleza (91.5%), with family income up to a minimum wage (76.8%). Regarding the clinical data, they presented a medical diagnosis of non-progressive chronic encephalopathy (76.8%), quadriplegic (74.60%) and motor spasticity (60.32%), without exclusive breastfeeding (85.4%), 100% used a bottle during the lactation / breastfeeding period, and 82.9% used pacifiers daily. The prevalence of nursing diagnosis Deglutition impaired was 59.76%. It was observed that the adjusted model showed maximum entropy value with 16 defining characteristics. Clinical indicators with good measures of sensitivity were: lack of action to form the cake (100%), slow cake formation (100%), inefficient uptake (81.67%), observed evidence of difficulty swallowing (87,79 %) and food falls from the mouth (79.63%). Good specificity measures were found in the inability to empty the oral cavity (100%), slow formation of the cake (100%), refusal to eat (100%), lack of action to form the cake (100%), lack of chewing (100%), observed evidence of difficulty in swallowing (87.80%) and awakening during the nocturnal period (81.70%). Thus, these clinical indicators are essential to predict the presence of impaired swallowing in children with neurological dysfunctions. In this sense, the identification of sensitive and specific clinical indicators becomes fundamental for a diagnostic inference, directing the actions to be performed by the nursing team.