Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2022; 10(36): 13274-13283
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13274
Predictive value of the unplanned extubation risk assessment scale in hospitalized patients with tubes
Kun Liu, Zheng Liu, Lin-Qian Li, Meng Zhang, Xue-Xue Deng, Hong Zhu
Kun Liu, Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
Zheng Liu, Lin-Qian Li, Meng Zhang, Xue-Xue Deng, Hong Zhu, Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Liu K and Zhu H contributed to the conception and design of the work, and to data acquisition and interpretation, data analysis and drafted the paper; Liu Z and Deng XX contributed to data acquisition and interpretation; Li LQ and Zhang M contributed to data analysis and assisted in interpretation and drafting the paper; All authors contributed to the critical reversion of the paper and approved the final manuscript for publication; All authors have agreed to be accountable for all aspects of the work. Liu K and Zhu H are responsible for the overall content as guarantors.
Supported by West China Nursing Discipline Development Special Fund Project, Sichuan University, No. HXHL19059.
Institutional review board statement: Ethics approval was obtained from the Ethics Committee of the West China Hospital of Sichuan University (No.2022-512).
Informed consent statement: This study has been exempted from the informed consent application.
Conflict-of-interest statement: All the authors have no competing interests to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Zhu, MD, RN, Professor, Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. zhuhong816@wchscu.cn
Received: September 7, 2022
Peer-review started: September 7, 2022
First decision: November 11, 2022
Revised: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Abstract
BACKGROUND

Critical patients often had various types of tubes, unplanned extubation of any kind of tube may cause serious injury to the patient, but previous reports mainly focused on endotracheal intubation. The limitations or incorrect use of the unplanned extubation risk assessment tool may lead to improper identification of patients at a high risk of unplanned extubation and cause delay or non-implementation of unplanned extubation prevention interventions. To effectively identify and manage the risk of unplanned extubation, a comprehensive and universal unplanned extubation risk assessment tool is needed.

AIM

To assess the predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale in inpatients.

METHODS

This was a retrospective validation study. In this study, medical records were extracted between October 2020 and September 2021 from a tertiary comprehensive hospital in southwest China. For patients with tubes during hospitalization, the following information was extracted from the hospital information system: age, sex, admission mode, education, marital status, number of tubes, discharge mode, unplanned extubation occurrence, and the Huaxi Unplanned Extubation Risk Assessment Scale (HUERAS) score. Only inpatients were included, and those with indwelling needles were excluded. The best cut-off value and the area under the curve (AUC) of the Huaxi Unplanned Extubation Risk Assessment Scale were been identified.

RESULTS

A total of 76033 inpatients with indwelling tubes were included in this study, and 26 unplanned extubations occurred. The patients’ HUERAS scores were between 11 and 30, with an average score of 17.25 ± 3.73. The scores of patients with or without unplanned extubation were 22.85 ± 3.28 and 17.25 ± 3.73, respectively (P < 0.001). The results of the correlation analysis showed that the correlation coefficients between each characteristic and the total score ranged from 0.183 to 0.843. The best cut-off value was 21, and there were 14135 patients with a high risk of unplanned extubation, accounting for 18.59%. The Cronbach’s α, sensitivity, specificity, positive predictive value, and negative predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale were 0.815, 84.62%, 81.43%, 0.16%, and 99.99%, respectively. The AUC of HUERAS was 0.851 (95%CI: 0.783-0.919, P < 0.001).

CONCLUSION

The HUERAS has good reliability and predictive validity. It can effectively identify inpatients at a high risk of unplanned extubation and help clinical nurses carry out risk screening and management.

Keywords: Inpatient, Unplanned extubation, Risk assessment, Prediction, Tube management

Core Tip: This was a retrospective validation study, in which 76033 inpatients with indwelling tubes were included. This study has validated the good predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale. The scale is applicable to the unplanned extubation risk assessment of all types of tubes. The best cut-off value of the scale is 21, and the area under the curve is 0.851.