How accurate is the AVPU scale in detecting neurological impairment when used by general ward nurses? An evaluation study using simulation and a questionnaire.

Brunker, Chris and Harris, Ruth (2015) How accurate is the AVPU scale in detecting neurological impairment when used by general ward nurses? An evaluation study using simulation and a questionnaire. Intensive and Critical Care Nursing, 31(2), pp. 69-75. ISSN (print) 0964-3397

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Abstract

OBJECTIVES: to evaluate accuracy, sensitivity, specificity and inter-rater agreement of AVPU (Alert, Voice, Pain, Unresponsive) when used by non-specialist nursing staff assessing consciousness, and to investigate users' views. METHODS: Video-recorded simulations of assessments of consciousness were developed and verified by an expert panel. Participants scored simulations using AVPU and completed questionnaires eliciting views on the scale. AVPU scores were compared with functional levels agreed by the panel. SETTING: A large urban teaching hospital. RESULTS: Fifty-one participants scored 255 simulations. Overall accuracy was 82.4% (95% CI=77.7-87.1%), sensitivity 0.94 (95% CI=0.90-0.98), specificity 0.74 (95% CI=0.66-0.82) and inter-rater agreement (un-weighted kappa) 0.782. Accuracy was low for simulations depicting an orientated patient whose eyes open to speech (49% correct) and a confused patient with spontaneous eye opening (61.5% correct). Sensitivity and agreement for levels corresponding to "Alert" and "Voice" were 0.81 (95% CI=0.69-0.93) and kappa=0.506. Participants expressed uncertainty about aspects of AVPU's use. CONCLUSIONS: AVPU had low rates of accuracy, sensitivity and agreement in distinguishing between "Alert" and "Voice", and low specificity overall, suggesting it may be unsuitable for early warning scoring. Participants expressed doubts about the use of AVPU.

Item Type: Article
Research Area: Nursing and midwifery
Faculty, School or Research Centre: Faculty of Health, Social Care and Education
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Depositing User: Automatic Import Agent
Date Deposited: 26 Jan 2015 11:48
Last Modified: 13 Mar 2017 16:52
URI: http://eprints.kingston.ac.uk/id/eprint/30290

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