Abstract

Highlights: What are the main findings? Eight clinical presentations, three oral trial elements, three oral trial protocols, and fourteen signs suggestive of oropharyngeal dysphagia were agreed on by panelists and the steering group to include in the novel Children’s Oral Feeding Screener (COFS) tool. The COFS is positioned as one of the first nurse-led pediatric dysphagia screening tools designed broadly for all children admitted to acute and/or critical care settings, which contains a structured fluid oral trial component spanning typical pediatric intake methods. What is the implication of the main finding? Initial content validity for three components of the COFS (red flags, oral trial elements/protocols, and observable signs of dysphagia) for use in children admitted to acute and/or critical care hospital settings has been developed through this eDelphi process. Further psychometric testing of the construct validity, sensitivity/specificity, inter-rater reliability, and feasibility of this tool in these settings remains to be established in future studies. 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.