Abstract: Objective: To evaluate the inter-rater reliability and diagnostic accuracy of the determination criteria of sputum retention among elderly patients with non-artificial airway. Methods: For inter-rater reliability, twenty patients were evaluated 76 times by two researchers on the basis of the criteria simultaneously and we calculated the consistency rates of each indication and the Kappa analysis. For accuracy of the criteria, we conducted 361 evaluations among 58 patients based on the criteria, and the results of nurses assisted discharging sputm were used as reference standards. The evaluations were completed before nurses assisted patients to discharge sputum with discharging sputum positive and no sputum negative. The sensitivity, specificity and other indexes were calculated. Results: The consistency rates for each indicators between the two researchers were more than 85%, and the Kappa was 0.79. The sensitivity of the criteria for determination of sputum retention was 80.51% with the specificity 91.57% , the odds ratio 44.86, the Youden index 0.72, the positive likelihood ratio 9.55, the negative likelihood ratio was 0.21, and the area under the ROC curve 0.86. Conclusion: The initial clinical validation shows that the criteria have good inter-rater reliability and accuracy. The results of this study could facilitate clinical nurses to detect sputum retention.

Key words: sputum retention; determination criteria; inter-rater reliability; sensitivity, specificity