Department of Rehabilitation, Azienda USL-IRCCS, Reggio Emilia, Italy.
Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Am Med Dir Assoc. 2019 Apr;20(4):470-475.e1. doi: 10.1016/j.jamda.2018.09.022. Epub 2018 Nov 16.
Patients with acquired brain injuries (ABIs) often need tracheostomy because of dysphagia. However, many of them may recover over time and be eventually decannulated during post-acute rehabilitation. We developed the Decannulation Prediction Tool (DecaPreT) to identify, early in the post-acute course, patients with ABIs who can be safely decannulated.
Nonconcurrent cohort study.
Patients with ABI, as well as with dysphagia and tracheostomy, were retrospectively selected from the database of a neurorehabilitation unit in Correggio, Reggio Emilia, Italy.
Potential bivariate predictors of decannulation were screened from variables collected on admission during clinical examination, conducted by an expert speech therapist. Multivariable prediction was then obtained in 2 separate random subsamples to develop and validate the logistic regression model of the DecaPreT.
Of 463 patients with ABI (mean age 52.2 years) selected, 73.0% could be safely decannulated before discharge. After bivariate screening, multivariable predictors of decannulation were identified in the development subsample and confirmed in the validation subsample, each with its odds ratio and 95% confidence interval as follows: age tertile (1.77, 1.08-2.89; P = .024), no saliva aspiration (3.89, 1.73-8.64; P = .001), pathogenesis of ABI (trauma vs other causes vs stroke vs anoxia: 2.23, 1.41-3.54; P = .001), no vegetative status (8.47; 2.91-24.63; P < .001), and coughing score (voluntary and reflex vs voluntary vs reflex vs neither voluntary nor reflex cough: 2.62, 1.70-4.05; P < .001). In the validation subsample, the predicting equation obtained an area under the receiver operating characteristics curve of 0.836.
The DecaPreT predicts safe decannulation in patients with dysphagia and tracheostomy, using simple clinical variables detected early in the post-acute phase of ABI. The tool can help clinicians choose timing and intensity of rehabilitation interventions and plan discharge.
患有后天性脑损伤（ABI）的患者常因吞咽困难而需要行气管切开术。但随着时间的推移，他们中的许多人可能会康复，并在急性后期康复期间被拔管。我们开发了拔管预测工具（DecaPreT），以便在急性后期早期识别可以安全拔管的 ABI 患者。
非同期队列研究。
从意大利雷焦艾米利亚省科雷焦神经康复科的数据库中回顾性选择了患有 ABI 以及吞咽困难和气管切开术的患者。
通过由专家言语治疗师进行的临床检查，在入院时收集的潜在双变量预测因素进行筛选。然后，在 2 个单独的随机子样本中进行多变量预测，以开发和验证 DecaPreT 的逻辑回归模型。
在纳入的 463 例 ABI 患者（平均年龄 52.2 岁）中，73.0%在出院前可安全拔管。在双变量筛选后，在发展子样本中确定了拔管的多变量预测因素，并在验证子样本中得到了证实，每个因素的优势比及其 95%置信区间如下：年龄三分位（1.77，1.08-2.89；P=0.024），无唾液吸入（3.89，1.73-8.64；P=0.001），ABI 的发病机制（创伤比其他原因比中风比缺氧：2.23，1.41-3.54；P=0.001），无植物状态（8.47；2.91-24.63；P<0.001）和咳嗽评分（自主和反射咳嗽比自主咳嗽比反射咳嗽比既无自主也无反射咳嗽：2.62，1.70-4.05；P<0.001）。在验证子样本中，获得的接收者操作特征曲线下面积为 0.836。
DecaPreT 使用 ABI 急性后期早期检测到的简单临床变量预测吞咽困难和气管切开患者的安全拔管。该工具可以帮助临床医生选择康复干预的时间和强度，并计划出院。
