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An Airway Risk Assessment Score for Unplanned Extubation in Intensive Care Pediatric Patients
Atul Vats1, Clara Hopkins, Kelly M Hatfield
11Children's Healthcare of Atlanta, Atlanta, GA. 2Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3Department of Respiratory Care, Children's Healthcare of Atlanta, Atlanta, GA. 4Georgia Institute of Technology, Atlanta, GA. 5School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA.
Insights
A new Risk Assessment Score tool helps predict unplanned extubations in pediatric patients. Higher scores indicate a greater risk, aiding in targeted safety interventions for intubated children.
Area of Science:
- Pediatric critical care medicine
- Patient safety research
- Clinical risk stratification
Background:
- Unplanned extubation is a significant risk in pediatric intensive care units (PICUs).
- A novel scoring tool, the Risk Assessment Score (RAS), was developed to identify patients at high risk.
- The RAS stratifies patients into low, moderate, high, and extreme risk categories.
Purpose of the Study:
- To evaluate the correlation between the Risk Assessment Score and the actual occurrence rate of unplanned extubations in pediatric patients.
- To determine if the RAS can effectively predict the likelihood of unplanned extubation.
Main Methods:
- A retrospective review of 2,811 intubated pediatric patients across five ICUs in a large children's healthcare system.
- Data collected included intubation details, Risk Assessment Scores, and extubation outcomes.
- Analysis compared extubation rates across demographic groups and correlated them with maximum RAS scores.
Main Results:
- The overall rate of unplanned extubation was 5.3% (244 out of 4,566 intubations).
- Occurrence rates increased with higher Risk Assessment Scores: low (4.7%), moderate (7.7%), high (12.0%), and extreme (8.3%).
- Higher RAS scores demonstrated a clear association with increased unplanned extubation rates per 100 ventilator days.
Conclusions:
- The Risk Assessment Score is a valuable tool for predicting unplanned extubations in pediatric patients.
- Higher scores on the RAS are significantly associated with higher rates of unplanned extubation.
- Implementing the RAS can guide targeted monitoring and interventions to enhance patient safety.
Objective:
As a result of a workshop to identify common causes of unplanned extubation, Children's Healthcare of Atlanta developed a scoring tool (Risk Assessment Score) to stratify patients into groups of low, moderate, high, and extreme risk. This tool could be used to institute appropriate monitoring or interventions for patients with high risks of unplanned extubation to enhance safety. The objective of this study is to test the hypothesis that the Risk Assessment Score will correlate with the occurrence rate of unplanned extubation in pediatric patients.
Design:
Retrospective review of 2,811 patients at five ICUs conducted between December 2012 and July 2014.
Setting:
Five ICUs at two freestanding pediatric hospitals within a large children's healthcare system in the United States.
Patients:
All intubated pediatric patients.
Interventions:
Data of intubations and Risk Assessment Score were collected. Extubation outcomes and severity levels were compared across demographic groups and with the maximum Risk Assessment Score of each intubation.
Measurements And Main Results:
Out of 4,566 intubations, 244 were unplanned extubations (5.3%). The occurrence rates of unplanned extubations in those less than 1, 1-6, and more than 6 years old were 6.7%, 3.6%, and 2.7%, respectively, corresponding to a rate of 0.59, 0.53, and 0.58 unplanned extubation every 100 ventilator days. The occurrence rates were 13.6% for patients weighing less than 1 kg (0.59 unplanned extubation per 100 ventilation days) and 3.8% for patients weighing greater than or equal to 1 kg (0.58 unplanned extubation per 100 ventilation days). For intubations with maximum risk score falling in risk categories of low, moderate, high, and extreme, the occurrence rates were 4.7%, 7.7%, 12.0%, and 8.3%, respectively, which corresponded to rates of 0.54, 0.62, 0.95, and 0.92 unplanned extubation per 100 ventilator days.
Conclusions:
Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation.
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