Tradução, adaptação cultural e validação para o português do Brasil da escala de alerta precoce Hamilton Early Warning Score – HEWS.

Abstract

The emergency medical service is a complex environment, often chaotic and overcrowded, which increases the vulnerability of the patient to evolve with deterioration of the clinical condition without being recognized by the care team. This adverse event can progress to critical events, such as cardiac arrest and death. In turn, in a hospital environment, cardiorespiratory arrest rarely occurs suddenly, but as a result of the progressive deterioration of physiological functions and is preceded by signs of clinical worsening. Early detection and intervention are opportunities to prevent further damage and increase patient safety. To this end, early warning scores were developed, they are systems that generate a score that increases according to the patient's instability. The Hamilton Early Warning Score is one of these instruments, it stands out for its applicability and validity. HEWS was not found translated and validated for Brazilian Portuguese. This study aimed to carry out the translation, cross-cultural adaptation and validation of HEWS into Brazilian Portuguese. It is a methodological research developed in two stages: translation, adaptation and apparent or face validation of the instrument for Brazilian language and culture and analysis of its metric properties. After authorization by the author of the instrument, in the first stage the methodological process of initial translation, synthesis, back translation, analysis by the expert committee and pre-test was adopted. In the second stage, the analysis of inter-observer reliability, the validity of concurrent criteria and predictive validity were performed to predict critical events of cardiorespiratory arrest, death and referral to the ICU. The translated and adapted HEWS obtained an initial validity index of 0.89 and after a consensus meeting, the Brazilian HEWS version was generated with 100% agreement by the committee of judges. In the second stage, inter-observer reliability obtained an excellent correlation of 0.924 (p <0.001) for the total score and high to very high agreement strength of 0.83 to 1.0 (p <0.001) for the individual items of the scale. Concurrent criterion validity identified a statistically strong and negative correlation r = - 0.75 with the Canadian Acute Scale Triage. In the validity of the predictive criterion, logistic regression presented an odds ratio of 1.63 95% CI, (1.358 - 1.918), p <0.001. The accuracy for combined events (CRP, death and transfer to the ICU) was good with a value of 0.89 (0.831 - 0.953, 95% CI) and statistically significant, p <0.001. Sensitivity and specificity was assessed from the cutoff points ≥3, ≥6 and ≥9, with the results sensitivity: 96.4%, 71.4% and 46.4% respectively and specificity of 60%, 86.9 % and 96.9% respectively, consistent with the ROC curve and the literature. It is concluded that HEWS was successfully translated and adapted for the Brazilian context and is a valid and reliable instrument that can assist in the recognition of patients in clinical deterioration, in risk management and conduct determination, with a view to patient safety, resource management and quality of care.