Elaboração e validação de conteúdo de um instrumento para classificação de paciente cirurgico de urgência

Abstract

To develop as well as to validate the content of an emergency surgical classification instrument using the Delphi technique. METHODS: Methodological research with descriptive design, aiming at the elaboration and validation of the content of an instrument for the Classification of Emergency Surgical Patients using the Delphi technique; a technique that provides consensus among specialists of a certain area. Study with doctors graduated at least five years ago, with a minimum qualification of specialists and inserted in the practice of emergency surgical patient care. Doctors from the specialties such as General Surgery, Orthopedics, Plastic Surgery, Vascular Surgery, Urology, Thoracic Surgery, Neurosurgery or Otorhinolaryngology have comprised the instrument validation. For the development of the instrument, the phases of the Delphi technique were used, namely: Establishment of the conceptual structure, Definition of the instrument's objectives and the population involved, Construction of the items; Construction of response scales; Phase Selection and organization of items; Instrument structure and Content Validity. After the phases were completed ,an instrument was structured providing two domains: domain 1 with 44 items of signs and symptoms in common use between specialties, and domain 2 with items for use in specialties. For statistical analysis, the content validity index was used with the agreement rate of 75% for domain1 and 100% for domain 2. RESULTS: Among the 40 instruments that were sent, 22 expert doctors have anwered; predominantly males (90.90%), with at least five years of training and with a minimum degree of specialist. Of the 44 items evaluated in domain 1; 14 (31.81%) were validated, with the items with the highest agreement (very important) blood loss (90%), followed by hypotension (72.72%) and the lowest index is leukometry; three (13.63%) medical experts considered this item to be very important for the instrument. The specific instruments, which contained six specific items by specialty, the agreement of validated items was from five items 83.33% of General Surgery, Orthopedics and Vascular Surgery to one (16.66%) of Plastic surgery. When questioned the importance of having an instrument to classify a surgical patient as to the degree of urgency, it was unanimous that everyone has agreed that this need exists, thus strengthening this research objective. Conclusions: The instrument developed in this study is the first developed specifically for the classification of emergency surgical patients according to the priority in surgical care. The union referring to items in common use with those related to specialties forming the instrument for the classification of emergency surgical patients provides a new view for the individualized assessment of the patient, as well as assists in the decision-making of health professionals, these being based on use of an objective instrument with scientific and practical support. Therefore, it is suggested that this advance will assist in the organization of the emergency unit and surgical center, providing patient ´s safety, time and financial management of the institution.