title: Self-extubation risk assessment tool: predictive validity in a real-life setting.
abstract: OBJECTIVE
  To evaluate the predictive validity of the self-extubation risk assessment tool (SERAT) in intensive care patients.
  
  
  BACKGROUND
  Unplanned extubation is an important complication in intensive care units (ICUs). Physicians and nurses working in the ICU would benefit by having access to a tool that could reliably identify patients at risk for unplanned extubation. The SERAT is a risk stratification scheme developed to identify patients at risk for deliberate self-extubation.
  
  
  METHODS
  A prospective, diagnostic study.
  
  
  METHODS
  Over a 3-month period, 256 patients who were admitted in one of five ICUs in four hospitals in Flanders (Belgium) were studied. The Glasgow Coma Scale and the Bloomsbury Sedation Score were completed by nurses at the start of each shift, i.e. three times per day. Independent nurse researchers collected data on planned or unplanned extubation and placed the data in the SERAT classification scheme.
  
  
  RESULTS
  Five self-extubations and three accidental extubations occurred during the 3-month study period, yielding an incidence of 4.47% that corresponded to 0.56 unplanned extubations per 100 ventilation days. Using the highest accuracy model, we determined that the SERAT had a sensitivity of 100%, specificity of 90%, negative predictive value of 100%, positive predictive value of 1.2% and accuracy of 90%.
  
  
  CONCLUSIONS
  Although the SERAT can correctly identify patients at risk for deliberate self-extubation, its use also produces a high number of false-positive identifications. Further research is necessary to evaluate how the false-positive rate can be reduced, and subsequently, the predictive validity of the SERAT can be improved.
  
  
  CONCLUSIONS
  Because of the high number of false positives, the use of the SERAT in clinical practice to date is not advocated. The positive predictive value has to be improved to avoid the implementation of intensive interventions in patients who are not at risk.
authors.affiliation: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, University Hospitals of Leuven, Leuven, Belgium. philip.moons@med.kuleuven.be
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.forename: Marion
authors.initials: M
authors.lastname: Boriau
authors.forename: Patrick
authors.initials: P
authors.lastname: Ferdinande
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D001530:Belgium; D016292:Procedural Sedation / Q000009:adverse effects; D003422:Critical Care / Q000379:methods; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000451:nursing* / Q000523:psychology; D016013:Likelihood Functions; D008297:Male; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015403:Nursing Evaluation Research; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016312:Treatment Refusal