title: Screening for Voice Disorders in Older Adults (RAVI)-Part III: Cutoff Score and Clinical Consistency.
abstract: OBJECTIVE
  The aim of the study was to determine the cutoff score and clinical consistency of "Screening for Voice Disorders in Older Adults" (RAVI-Rastreamento de Alterações Vocais em Idosos).
  
  
  METHODS
  This is a prospective, nonrandomized, cross-sectional diagnostic study.
  
  
  METHODS
  A sample of 301 subjects, including both sexes, aged 60 and more, and all of whom were living in either a community or an institution, was studied. To determine which subjects had or did not have voice problems, we used a composite reference standard (auditory-perceptual analysis of sustained vowel phonation, auditory-perceptual analysis of connected speech, and vocal self-assessment). The best cutoff score was identified using the receiver operating characteristic (ROC) curve analysis. The clinical consistency indicators were co-positivity, co-negativity, positive and negative predictive values, positive and negative likelihood ratio, and test efficiency. The significance level was 5%.
  
  
  RESULTS
  The area under the ROC curve was 0.763 (95% confidence interval: 0.706-0.821), and the best cutoff score for determining which older adults had or did not have a voice disorder was 2. All clinical consistency indicators were satisfactory: co-positivity (79%), co-negativity (60%), predictive positive value (51%), negative predictive value (84%), positive likelihood ratio (2.01), negative likelihood ratio (0.34), and test efficiency (69%).
  
  
  CONCLUSIONS
  RAVI has satisfactory indicators of clinical consistency and is able to determine which older adults have voice disorders by a cutoff score of 2. The use of RAVI as a screening tool is recommended to help determine the prevalence of voice disorders in older adults.
authors.affiliation: Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Paraíba, Brazil. Electronic address: leandroape@globo.com.
authors.forename: Leandro
authors.initials: L
authors.lastname: Pernambuco
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Servei d'Atenció i Prevenció a les Drogodependències, Barcelona, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; CIBER de Epidemiologia y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Espelt
authors.affiliation: Programa de Pós-graduação em Saúde Coletiva (PPGSCol-UFRN), Universidade Federal do Rio Grande do Norte (UFRN), Rio Grande do Norte, Brazil.
authors.forename: Kenio
authors.initials: K
authors.lastname: Costa de Lima
mesh_terms: D000162:Acoustics; D000367:Age Factors; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012649:Self Concept; D013061:Speech Acoustics; D013067:Speech Perception; D013068:Speech Production Measurement; D013066:Speech-Language Pathology / Q000379:methods*; D011795:Surveys and Questionnaires; D014832:Voice Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D014833:Voice Quality
keywords: aging; diagnostic studies; epidemiology; validation studies; voice disorders