title: Development of a risk assessment tool for deliberate self-extubation in intensive care patients.
abstract: OBJECTIVE
  To develop a risk stratification scheme for deliberate self-extubation in intensive care patients.
  
  
  METHODS
  A nested case-control study.
  
  
  METHODS
  Four surgical ICUs, one medical ICU, one coronary care unit, and one emergency department of a tertiary care center.
  
  
  METHODS
  In a 3-month period, the number of ventilation periods, ventilation days, and unplanned extubations were recorded. Potential determinants of unplanned extubation were assessed with a translated (English to Dutch) and modified version of the "Unplanned Extubation Data Collection Tool."
  
  
  METHODS
  Clinical and demographic characteristics and circumstances of the 26 unplanned extubations were compared with those of 48 randomly selected control patients who did not experience unplanned extubation.
  
  
  RESULTS
  The incidence of unplanned extubation was 4.2%, corresponding to 0.68 unplanned extubations per 100 ventilation days. The incidence was substantially lower at surgical ICUs (2.6%) compared with that at medical ICU/CCUs (9.5%). Multiple logistic regression analysis revealed that patients with a low sedation level (Bloomsbury Sedation Score) and a higher degree of consciousness (Glasgow Coma Scale) were at higher risk for deliberate self-extubation. The explained variance of this model including these factors was 67.3%.
  
  
  CONCLUSIONS
  Based on the risk factors identified, a risk assessment tool was developed. Systematic administration of the Bloomsbury Sedation Score and the Glasgow Coma Scale, and the use of the stratification scheme, allows identification of patients at risk. Appropriate reduction of sedative drugs during weaning, a timely extubation, and increased surveillance in patients identified to be at risk are possible interventions to diminish the number of unplanned extubations.
authors.affiliation: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium. Philip.Moons@med.kuleuven.ac.be
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.forename: Kristine
authors.initials: K
authors.lastname: Sels
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Becker
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
authors.forename: Patrick
authors.initials: P
authors.lastname: Ferdinande
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012121:Respiration, Artificial; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D012646:Self Administration / Q000009:adverse effects* / Q000379:methods; D012648:Self Care / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome