External Validation and Calibration of the DecaPreT Prediction Model for Decannulation in Patients with Acquired Brain Injury

Elio Leto,Paolo Scola,Maria Ursino,Danilo Lofaro,Antonio Cerasa,Paolo Tonin,Domenico Conforti,Stefania Rogano,Lucia Francesca Lucca

doi:10.3390/brainsci11060799

Abstract

We propose a new set of clinical variables for a more accurate early prediction of safe decannulation in patients with severe acquired brain injury (ABI), during a post-acute rehabilitation course. Starting from the already validated DecaPreT scale, we tested the accuracy of new logistic regression models where the coefficients of the original predictors were reestimated. Patients with tracheostomy were retrospectively selected from the database of the neurorehabilitation unit at the S. Anna Institute of Crotone, Italy. New potential predictors of decannulation were screened from variables collected on admission during clinical examination, including (a) age at injury, (b) coma recovery scale-revised (CRS-r) scores, and c) length of ICU period. Of 273 patients with ABI (mean age 53.01 years; 34% female; median DecaPreT = 0.61), 61.5% were safely decannulated before discharge. In the validation phase, the linear logistic prediction model, created with the new multivariable predictors, obtained an area under the receiver operating characteristics curve of 0.901. Our model improves the reliability of simple clinical variables detected at the admission of the post-acute phase in predicting decannulation of ABI patients, thus helping clinicians to plan better rehabilitation.

Highlights

In patients with severe acquired brain injury (ABI), a tracheostomy is usually performed during the first days after the acute event when there is a need for prolonged mechanical ventilation and airway protection in the intensive care unit (ICU) [1]
From an initial cohort of 353 ABI patients, we enrolled only those who fulfilled the following inclusion criteria: (1) age ≥ 18 years; (2) presence of tracheostomy cannula on hospital admission; (3) severe ABI with Glasgow Coma Scale (GCS) ≤ 8 as measured at intensive care unit (ICU) discharge, identified based on ICU medical records relating to to the acute phase; (4) first admission to the neurorehabilitation unit
We combined a series of clinical variables into a multimodal model that estimates the probability of safe decannulation with an area under the ROC curve (AUC) of about 90%

Summary

Introduction

In patients with severe acquired brain injury (ABI), a tracheostomy is usually performed during the first days after the acute event when there is a need for prolonged mechanical ventilation and airway protection in the intensive care unit (ICU) [1]. Using a logistic regression model, Heidler et al [13] found three particular clinical factors strictly associated with the probability of decannulation in 831 tracheotomized and weaned patients: age, prolonged duration of mechanical ventilation, and medical complications. The set of variables included in this tool were age, the pathogenesis of ABI, saliva aspiration, voluntary and reflex cough, and the level of consciousness. They demonstrated, in a relatively large population of patients with severe dysphagia secondary to ABI, that DecaPreT predicts effective decannulation with an accuracy of 83%

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