Development of a risk score to predict extubation failure in patients with traumatic brain injury.

PURPOSE: To identify predictors and develop a risk score for the prediction of extubation failure in TBI patients. MATERIALS AND METHODS: We prospectively evaluated 311 TBI adults receiving mechanical ventilation for >48h in the intensive care unit. Epidemiological, ventilatory, airway protective, laboratory, and hemodynamic predictors were evaluated. A multiple logistic regression model was developed to predict the extubation failure risk. A score was developed using the arithmetic sum of the points for each independent predictor, whose scores were proportional to the regression coefficient. The accuracy of the model was determined using the C statistic. RESULTS: Extubation failure occurred in 43 patients (13.8%). Five independent predictors were identified: female sex (4 points) Glasgow Coma Scale motor score≤5 (4 points), moderate-to-large secretion volume (4 points), absent or weak cough (3 points), and mechanical ventilation≥10days (2 points). We calculated the risk score for patients and three risk categories were defined: low (0-3 points), moderate (4-7 points), high (8-17 points). The extubation failure rates in the three groups were 3.5%, 21.2%, and 42.9%, respectively. CONCLUSION: The score developed to predict extubation failure in TBI patients can identify three risk categories and can be easily applied in the ICU.

Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study.

BACKGROUND: Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. METHODS: This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. RESULTS: Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. CONCLUSIONS: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.