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Predicting and preventing tracheostomy risk in pediatrics: Development and pilot testing of a focused assessment tool

Rebecca Brooks1, Pauline Chen1, Romaine Johnson2

  • 1Children's Health, 1935 Medical District Drive, Dallas, TX, 75235, USA.

International Journal of Pediatric Otorhinolaryngology
|May 17, 2026
PubMed

Insights

A new tool, the Children's Health Decannulation Risk Assessment Tool (CH-DRAT), effectively identifies pediatric patients at risk for accidental tracheostomy decannulation, significantly reducing adverse events.

Area of Science:

  • Pediatric critical care
  • Patient safety
  • Clinical assessment tools

Background:

  • Accidental tracheostomy decannulation poses significant risks to pediatric patients, including harm and increased healthcare costs.
  • Lack of standardized tools for identifying decannulation risk complicates patient management.
  • Tracheostomy-dependent children require vigilant monitoring to prevent adverse events.

Purpose of the Study:

  • To develop and evaluate the Children's Health Decannulation Risk Assessment Tool (CH-DRAT).
  • To create a focused assessment instrument to mitigate accidental decannulation risk in hospitalized pediatric patients.
  • To enhance patient safety for children with tracheostomies.

Main Methods:

  • Instrument development followed by content validation and inter-rater reliability assessment.
  • A pilot study evaluated the CH-DRAT's psychometric properties, including predictive validity, sensitivity, specificity, and reliability.
  • Statistical analysis of pilot data informed the tool's validation.

Main Results:

  • The CH-DRAT demonstrated strong predictive validity, sensitivity, and specificity.
  • A statistically significant 37% reduction in accidental decannulation rates was observed post-implementation.
  • The tool proved effective in identifying high-risk pediatric patients.

Conclusions:

  • The CH-DRAT is a reliable and valid instrument for assessing accidental decannulation risk in pediatric patients.
  • Implementation of the CH-DRAT has the potential to improve clinical decision-making.
  • The tool can lead to better patient outcomes and reduced healthcare burdens.
Abstract

Keywords:
AssessmentInstrumentationNursingPediatricQuality improvementTracheostomy decannulation

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