{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:09:32Z","timestamp":1792814972159,"version":"4.5.0"},"reference-count":23,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006041","name":"Innovate UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,9,29]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1\u20139.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0\u2013100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The pH test was the safest under cut-off 5 when there was \u226530% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ISRCTN11170249; Pre-results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018128","type":"journal-article","created":{"date-parts":[[2017,11,4]],"date-time":"2017-11-04T05:30:14Z","timestamp":1509773414000},"page":"e018128","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7356-848X","authenticated-orcid":false,"given":"Melody Zhifang","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer, St Mary\u2019s Hospital, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy R","family":"Huddy","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, St Mary\u2019s Hospital, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver H","family":"Priest","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, St Mary\u2019s Hospital, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sisse","family":"Olsen","sequence":"additional","affiliation":[{"name":"Specialist Surgery, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence D","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Management, London School of Economics and Political Sciences, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick M M","family":"Bossuyt","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Biostatistics and Bioinformatics (KEBB), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George B","family":"Hanna","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, St Mary\u2019s Hospital, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,11,4]]},"reference":[{"key":"2025121404064052000_7.11.e018128.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.330.7489.438"},{"key":"2025121404064052000_7.11.e018128.2","first-page":"32","article-title":"What is the prevalence of feeding tube placement errors and what are the associated risk factors?","volume":"4","author":"Ellett","year":"1997","journal-title":"Online J Knowl Synth Nurs"},{"key":"2025121404064052000_7.11.e018128.3","doi-asserted-by":"publisher","DOI":"10.1177\/0148607107031004269"},{"key":"2025121404064052000_7.11.e018128.4","unstructured":"NICE. Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition. London: NICE, 2006. https:\/\/www.nice.org.uk\/guidance\/cg32 (accessed 10 Jul 2015)."},{"key":"2025121404064052000_7.11.e018128.5","unstructured":"NHS National Patient Safety Agency. Patient safety alert 05: reducing the harm caused by misplaced nasogastric feeding tubes, 2005."},{"key":"2025121404064052000_7.11.e018128.6","unstructured":"NHS National Patient Safety Agency. Reducing the harm caused by misplaced nasogastric feeding tubes: interim advice for healthcare staff 2005."},{"key":"2025121404064052000_7.11.e018128.7","unstructured":"NHS National Patient Safety Agency. NPSA \u2013 Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants, 2011. http:\/\/www.nrls.npsa.nhs.uk\/EasySiteWeb\/getresource.axd?AssetID=129696&type=full&servicetype=Attachment (accessed Aug 2017)."},{"key":"2025121404064052000_7.11.e018128.8","unstructured":"Hanna GB , Priest O , Ni M , et al . Improving the safety of nasogastric feeding tube insertion: A Report for the NHS Patient Safety Research Portfolio, 2010. http:\/\/www.birmingham.ac.uk\/Documents\/college-mds\/haps\/projects\/cfhep\/psrp\/finalreports\/PS048ImprovingthesafetyofnasogastricfeedingtubeinsertionREVISEDHannaetal.pdf (accessed 31 Jul 2017)."},{"key":"2025121404064052000_7.11.e018128.9","doi-asserted-by":"crossref","first-page":"272","DOI":"10.4103\/0971-9784.154502","article-title":"Malposition of a nasogastric tube","volume":"18","author":"Raut","year":"2015","journal-title":"Ann Card Anaesth"},{"key":"2025121404064052000_7.11.e018128.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d2586"},{"key":"2025121404064052000_7.11.e018128.11","doi-asserted-by":"publisher","DOI":"10.1186\/cc120"},{"key":"2025121404064052000_7.11.e018128.12","unstructured":"Phillips LD . prioritisation and resoure allocation: application of decision analysis in pharmaceutical research and development. BMaB PA , ed. 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