Multidisciplinary Content Validation of the GiriMok Point-of-Care Protocol for Neonatal Cyanotic Congenital Heart Disease

Background Neonatal cyanotic congenital heart disease is a time-critical emergency requiring immediate bedside decision-making. Current guidelines lack a validated, comprehensive point-of-care (POC) protocol suitable for frontline clinicians in diverse settings. The GiriMok Protocol was developed to bridge this gap. This study aimed to develop and establish the content validity of the GiriMok POC Protocol through a rigorous four-phase iterative multidisciplinary expert validation process. Methodology This four-phase study comprised two external validation phases and two author-led refinement phases. Phase 1 involved 18 multidisciplinary experts using a 33-parameter mixed-methods instrument. Phase 2 consisted of focused revalidation by five specialists (neonatologists and a pediatric cardiologist) using a 16-item instrument with modified kappa (k*) computation. Phases 3 and 4 involved evidence-referenced enhancements against 2023-2025 guidelines and final quality assurance. Content Validity Index (CVI) was calculated at item (I-CVI) and scale (S-CVI/Ave) levels. Results In total, 18 unique validators participated across 24 episodes. Phase 1 yielded an S-CVI/Ave of 0.927, with all items meeting the I-CVI ≥0.78 threshold and zero safety concerns. Phase 2 achieved perfect scores (S-CVI/Ave = k* = 1.000) following the integration of a 22-item revision agenda. In total, 35 expert-informed corrections resulted in the final publication-ready GiriMok V4.0. Conclusions The GiriMok POC Protocol achieved unanimous multidisciplinary validation. The perfect Phase 2 CVI demonstrates methodological rigor and responsiveness to expert feedback. The protocol is now positioned for prospective clinical evaluation and national dissemination as a neonatal emergency decision-support tool.