BACKGROUND There is no widely accepted consensus on the weaning and extubating protocols for neurosurgical patients, leading to heterogeneity in clinical practices and high rates of delayed extubation and extubation failure-related health complications. METHODS In this single-center prospective observational diagnostic study, mechanically ventilated neurosurgical patients with extubation attempts were consecutively enrolled for 1 yr. Responsive physicians were surveyed for the reasons for delayed extubation and developed the Swallowing, Tongue protrusion, Airway protection reflected by spontaneous and suctioning cough, and Glasgow Coma Scale Evaluation (STAGE) score to predict the extubation success for neurosurgical patients already meeting other general extubation criteria. RESULTS A total of 3,171 patients were screened consecutively, and 226 patients were enrolled in this study. The rates of delayed extubation and extubation failure were 25% (57 of 226) and 19% (43 of 226), respectively. The most common reasons for the extubation delay were weak airway-protecting function and poor consciousness. The area under the receiver operating characteristics curve of the total STAGE score associated with extubation success was 0.72 (95% CI, 0.64 to 0.79). Guided by the highest Youden index, the cutoff point for the STAGE score was set at 6 with 59% (95% CI, 51 to 66%) sensitivity, 74% (95% CI, 59 to 86%) specificity, 90% (95% CI, 84 to 95%) positive predictive value, and 30% (95% CI, 21 to 39%) negative predictive value. At STAGE scores of 9 or higher, the model exhibited a 100% (95% CI, 90 to 100%) specificity and 100% (95% CI, 72 to 100%) positive predictive value for predicting extubation success. CONCLUSIONS After a survey of the reasons for delayed extubation, the STAGE scoring system was developed to better predict the extubation success rate. This scoring system has promising potential in predicting extubation readiness and may help clinicians avoid delayed extubation and failed extubation-related health complications in neurosurgical patients. EDITOR’S PERSPECTIVE

中文翻译：

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开发用于评估机械通气神经外科患者拔管准备情况的预测评分。

背景 对于神经外科患者的脱机和拔管方案尚未达成广泛接受的共识，导致临床实践中的异质性以及延迟拔管和拔管失败相关健康并发症的高发生率。方法 在这项单中心前瞻性观察性诊断研究中，连续入组尝试拔管的机械通气神经外科患者一年。对有反应的医生进行了延迟拔管原因的调查，并制定了吞咽、伸舌、自发咳嗽和吸痰反映的气道保护以及格拉斯哥昏迷量表评估 (STAGE) 评分，以预测已满足其他一般拔管标准的神经外科患者的拔管成功。结果 连续筛查患者3171例，纳入本研究226例。延迟拔管和拔管失败率分别为 25%（226 例中的 57 例）和 19%（226 例中的 43 例）。延迟拔管的最常见原因是气道保护功能弱和意识差。与拔管成功相关的总 STAGE 评分的受试者工作特征曲线下面积为 0.72（95% CI，0.64 至 0.79）。在最高 Youden 指数的指导下，STAGE 评分的截止点设置为 6，敏感性为 59%（95% CI，51% 至 66%），特异性为 74%（95% CI，59% 至 86%），特异性为 90%（ 95% CI，84% 至 95%）阳性预测值，30%（95% CI，21% 至 39%）阴性预测值。当 STAGE 评分为 9 或更高时，该模型在预测拔管成功方面表现出 100%（95% CI，90% 至 100%）的特异性和 100%（95% CI，72% 至 100%）的阳性预测值。结论 在对延迟拔管的原因进行调查后，开发了 STAGE 评分系统，以更好地预测拔管成功率。该评分系统在预测拔管准备情况方面具有广阔的潜力，可以帮助临床医生避免神经外科患者延迟拔管和拔管失败相关的健康并发症。编辑的观点