Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI) as a Safety Tool in Cardiothoracic Surgery

Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.摘要与引言：当前临床手术中使用的多数风险分层评分并未将外部及非技术因素作为术后并发症与死亡的预测指标。研究目的：本研究旨在对巴西版手术中断指数（Disruptions in Surgery Index, DiSI）问卷进行跨文化调适与翻译。该问卷最初用于采集手术团队各成员对可能引发手术失误、阻碍安全手术流程的各类中断事件的自我感知情况。研究方法：本研究采用普适性研究方法评估条目与语义的概念等效性，具体分为以下四个阶段：(1) 将原问卷翻译为葡萄牙语；(2) 将葡萄牙语版本回译为英语；(3) 组建专家小组拟定问卷初版；(4) 针对43名心胸外科从业人员组成的目标人群开展预试验，以评估条目语言理解度。研究结果：本研究成功将原问卷翻译为葡萄牙语，最终版问卷共包含29个条目，经专家小组评估认可度达89.6%。目标人群均认为所有条目易于理解；预试验中采用心理测量学李克特量表（Likert scale，满分5分）评估的整体清晰度与语言理解度平均分达4.48±0.16。研究结论：基于本次研究采用的方法、专家分析结果及预试验数据，本研究已圆满完成手术中断指数葡萄牙语版的翻译与跨文化调适核心流程。