Cent Eur J Nurs Midw 2016, 7(2):412-419 | DOI: 10.15452/CEJNM.2016.07.0009

Inter-rater agreement of the Brief Bedside Dysphagia Screening Test-Revised in patients with stroke

Petra Mandysová^1,2,*, Helena Trundová¹, Edvard Ehler^2,3

¹ Department of Nursing, Faculty of Health Studies, University of Pardubice, Czech Republic

² Department of Neurology, Pardubice Hospital, Hospitals of the Pardubice Region, Czech Republic

³ Department of Clinical Subspecialties, Faculty of Health Studies, University of Pardubice, Czech Republic

Aim: The aim of the study was to investigate the inter-rater agreement (IRA) of the 8-item Brief Bedside Dysphagia Screening Test-Revised (BBDST-R).

Design: An observational IRA study was conducted.

Methods: Forty-six patients with stroke were independently assessed by two nurse raters using the BBDST-R. Rater agreement was described and analysed using descriptive statistics, Cohen's kappa (κ), the proportion of observed agreement (P_o), the prevalence index (p_index), and the bias index (b_index).

Results: Kappa ranged from -0.046 (p = 0.641; 95% CI = -0.126-0.034) for item "ability to clench the teeth" to 0.784 (p < 0.001; 95% CI = 0.377-1.000) for "thick liquid: cough". For the overall BBDST-R result, κ was 0.241 (p = 0.114; 95% CI = 0.000-0.558). The Po was ≥ 0.80 for five items; the p_index was ≥ 0.80 for three items. The b_index ranged from 0.03-0.31.

Conclusion: The IRA, as expressed by κ, was low for the overall result and variable for the individual items. However, for some items, κ may have misrepresented the IRA due to the high p_index and b_index. Several strategies are recommended to improve the IRA of the instrument. This should enhance the instrument's capacity to produce consistent results across raters.

Keywords: Brief Bedside Dysphagia Screening Test-Revised, inter-rater agreement, dysphagia screening, nurse, stroke

Received: October 17, 2015; Accepted: November 18, 2015; Published: September 30, 2016  Show citation