Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton / Consequences of errors in the translation of questionnaires: spanish version of Downton index

La aplicación de escalas para detectar el riesgo de caídas en pacientes hospitalizados se ha generalizado. Durante el desarrollo de una revisión sistemática se detectó una disparidad grave en 3 ítems de la versión española del índice Downton respecto a la versión original. El objetivo de este estudio fue determinar el impacto de este error y comparar el riesgo estimado de caídas con cada versión, su validez y consistencia interna. Material y métodos. Se realizó un estudio transversal descriptivo en pacientes agudos hospitalizados durante 2011 en el Hospital Costa del Sol, Marbella. El riesgo de caídas de los pacientes se valoró mediante la versión española del índice Downton, y se recalculó conforme a los ítems de la versión original. Se calculó sensibilidad, especificidad y alfa de Cronbach. Resultados. La aplicación de la versión original de la escala redujo el número de pacientes clasificados como de «alto riesgo» de caer un 24,2%. Con la versión española de la escala, la posibilidad de ser clasificado como de «alto riesgo» de caer fue 3,3 veces mayor (OR: 3,3). Ambas versiones del índice Downton mostraron escasa precisión y validez diagnóstica. La sensibilidad de la escala original fue del 28% y la especificidad del 82%. Su consistencia interna fue baja (alfa de Cronbach: 0,51). Conclusiones. La escala Downton, dada su poca precisión y validez diagnóstica, baja consistencia interna y el error significativo observado en su traducción al español, no es el instrumento más adecuado para evaluar el riesgo de caídas en pacientes agudos hospitalizados (AU)

The application of screening tools to detect the risk of falls in hospitalized patients is in general use. During the development of a systematic review a serious disparity in three items of the Spanish version of the Downton index was detected, compared to the original version. The aim of this study was to determine the impact of this error and to compare the estimated risk of falls with each of these versions, its validity and internal consistency. Material and methods. A descriptive cross-sectional study in acute hospitalised patients was performed during 2011 in Hospital Costa del Sol, Marbella. The patients’ risk of falling was assessed by the Spanish version of the Downton index, and then it was re-calculated according to the items in the original version. Sensitivity, specificity and Cronbach's alpha were calculated. Results. Application of the original version of the index reduced the number of patients classified as “high risk” of falling by 24.2%. With the Spanish version of the tool, the possibility of being classed as “high risk” of falling was considerably 3.3 times higher (OR: 3.3). Both versions of the Downton index showed low accuracy and diagnostic validity. The sensitivity of the original scale was 28% and specificity of 82%. Its internal consistency was low (Cronbach's alpha: .51). Conclusions. The Downton index, given its poor accuracy and diagnostic validity, low internal consistency, and the significant error observed in its Spanish translation, is not the most appropriate tool to assess the risk of falls in hospitalised acute patients (AU)

[Consequences of errors in the translation of questionnaires: Spanish version of Downton index]. / Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton.

UNLABELLED: The application of screening tools to detect the risk of falls in hospitalized patients is in general use. During the development of a systematic review a serious disparity in three items of the Spanish version of the Downton index was detected, compared to the original version. The aim of this study was to determine the impact of this error and to compare the estimated risk of falls with each of these versions, its validity and internal consistency. MATERIAL AND METHODS: A descriptive cross-sectional study in acute hospitalised patients was performed during 2011 in Hospital Costa del Sol, Marbella. The patients' risk of falling was assessed by the Spanish version of the Downton index, and then it was re-calculated according to the items in the original version. Sensitivity, specificity and Cronbach's alpha were calculated. RESULTS: Application of the original version of the index reduced the number of patients classified as "high risk" of falling by 24.2%. With the Spanish version of the tool, the possibility of being classed as "high risk" of falling was considerably 3.3 times higher (OR: 3.3). Both versions of the Downton index showed low accuracy and diagnostic validity. The sensitivity of the original scale was 28% and specificity of 82%. Its internal consistency was low (Cronbach's alpha: .51). CONCLUSIONS: The Downton index, given its poor accuracy and diagnostic validity, low internal consistency, and the significant error observed in its Spanish translation, is not the most appropriate tool to assess the risk of falls in hospitalised acute patients.

The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit.

OBJECTIVE: To describe overall site-specific hospital-acquired infection (HAI) rates and to describe the microbiological and antibiotic resistance profiles of infecting pathogens, together with their impact on multidrug-resistant (MDR) bacteria-associated mortality. METHODS: We conducted a 5-year retrospective descriptive study of HAI in patients in the intensive care unit (ICU) of a cancer center in Mexico from January 2007 to December 2011. The following information was collected: patient characteristics and comorbidities, data related to the neoplasm and its treatment, microbiology, and the resistance pattern of all isolates. RESULTS: During the study period, 1418 patients were admitted to the ICU; 134 of them developed 159 infections, with an incidence of 11.2/100 hospitalized patients and 32.2/per 1000 patient-days. Two hundred sixty-six microorganisms were isolated. The overall prevalence of MDR-HAI was 39.5%. The most frequent organisms were as follows: 54 (20%) Escherichia coli (94.4% of these were extended-spectrum beta-lactamase producers), 32 (12%) Staphylococcus aureus (90.6% of these were methicillin-resistant), 32 (12%) Enterococcus faecium (18.7% of these were vancomycin-resistant), and 20 (6%) Acinetobacter baumannii (all were MDR). Among patients admitted to the ICU, 252 (17.8%) died. Death was related to the HAI in 58 (23%) of these patients (p<0.001) and 51 (88%) had a MDR organism isolated (p=0.05). CONCLUSIONS: The emergence of MDR bacteria poses a difficult task for physicians, who have limited therapeutic options. Critically ill cancer patients admitted to the ICU are at major risk of a bacterial MDR-HAI that will impact adversely on mortality.