title: The SETscore to Predict Tracheostomy Need in Cerebrovascular Neurocritical Care Patients.
abstract: Patients with severe stroke who require mechanical ventilation and neurointensive care unit (NICU) management often require a tracheostomy (TT). The optimal time point for TT remains unclear and a controversy in everyday NICU life. Here, we prospectively evaluated a score for prediction of TT need in NICU patients with cerebrovascular disease.
  
  
  
  Seventy-five consecutively ventilated stroke patients were prospectively included in the study and assessed by the stroke-related early tracheostomy score (SETscore) within the first 24 h of admission. Endpoints were TT need, NICU-length of stay (NICU-LOS), and ventilation time (VT). We examined the correlation of these variables with the SETscore using regression analysis and determined a cut-off by receiver operating characteristic (ROC) analysis.
  
  
  
  Twenty-six patients had to be tracheostomized. The mean VT was 8.7 ±8 days and the mean NICU-LOS was 11.6 ± 8 days. The SETscore predicted NICU-LOS with a positive predictive value of 0.748 (p < 0.001) and VT with a positive predictive value of 0.799 (p < 0.001). The ROC analysis demonstrated a SETscore value of 8 to be the optimal cut-off to predict prolonged NICU-LOS, VT, and TT need with a sensitivity of 64 % and a specificity of 86 %.
  
  
  
  Based on this monocentric study, the SETscore seems to be a valid tool to indicate prolonged NICU-LOS and VT, as well as TT need in cerebrovascular NICU patients. Confirmation of these results in larger cohorts with various settings may help to develop the SETscore as a decisive tool on primary TT early in time to avoid extubation failure.
authors: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors: Silvia
authors: S
authors: Schönenberger
authors: Neurocritical Care Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.|King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors: Faisal
authors: F
authors: Al-Suwaidan
authors: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors: Meinhard
authors: M
authors: Kieser
authors: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors: Lorenz
authors: L
authors: Uhlmann
authors: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. julian.boesel@med.uni-heidelberg.de.
authors: Julian
authors: J
authors: Bösel
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D014139:Tracheostomy / Q000379:methods* / Q000592:standards
keywords: Extubation failure; Intracerebral hemorrhage; Ischemic stroke; Subarachnoid hemorrhage; Tracheostomy