Welcome to the sixtith episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to a recent AEM Article or Article in Press, with an author interview podcast.

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DISCUSSING (OPEN ACCESS THROUGH APRIL 30th, 2022; CLICK ON TITLE TO ACCESS)

Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS)

Christine A. Capone MD, MPH, Beth Emerson MD, Todd Sweberg MD, Lee Polikoff MD, David A. Turner MD, Michelle Adu-Darko MD, FAAP, Simon Li MD, MPH, Lily B. Glater-Welt MD, Joy Howell MD, FAAP, FCCM, Calvin A. Brown III MD, Aaron Donoghue MD, MSCE, Conrad Krawiec MD, Justine Shults PhD, Ryan Breuer MD, Kelly Swain CPNP-AC, Asha Shenoi MD, FAAP, FCCM, Ashwin S. Krishna MD, MPH, FAAP, Awni Al-Subu MD, FAAP, Ilana Harwayne-Gidansky MD, MA, FAAP, CHSE, Katherine V. Biagas MD, FCCM, FAAP, Serena P. Kelly MS, CPNP-AC, FNP-BC, Gabrielle Nuthall MBChB, FRACP, FCICM, Josep Panisello MD, Natalie Napolitano MPH, RRT-NPS, FAARC, John S. Giuliano Jr. MD, FAAP, FCCM, Guillaume Emeriaud MD, PhD, Iris Toedt-Pingel MD, FAAP, Anthony Lee MD, Christopher Page-Goertz MD, FAAP, Dai Kimura MD, Mioko Kasagi MD, Jenn D'Mello MD, Simon J. Parsons MD, Palen Mallory MD, Masafumi Gima MD, G. Kris Bysani MD, MS, FCCM, Makoto Motomura MD, Keiko M. Tarquinio MD, FAAP, Sholeen Nett MD, PhD, Takanari Ikeyama MD, Rakshay Shetty MD(PGI), FRCPCH (UK), FICCM, Ronald C. Sanders Jr. MD, MS, Jan Hau Lee MBBS, MRCPCH, MCI, Matthew Pinto MD, Alberto Orioles MD, Philipp Jung MD, Mark Shlomovich MD, Vinay Nadkarni MD, MS, Akira Nishisaki MD, MSCE, for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators, Pediatric Acute Lung Injury, Sepsis Investigators (PALISI)

LISTEN NOW: INTERVIEW WITH AUTHOR

Abstract

Background

Tracheal intubation (TI) practice across pediatric emergency departments (EDs) has not been comprehensively reported. We aim to describe TI practice and outcomes in pediatric EDs in contrast to those in intensive are units (ICUs) and use the data to identify quality improvement targets.

Methods

Consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018 were analyzed for patient, provider, and practice characteristics and outcomes: adverse TI-associated events (TIAEs), oxygen desaturation (SpO2 < 80%), and procedural success. A multivariable model identified factors associated with TIAEs in the ED.

Results

A total of 756 TIs in 13 pediatric EDs and 12,512 TIs in 51 pediatric/cardiac ICUs were reported. Median (interquartile range [IQR]) patient age for ED TIs was higher (32 [7–108] months) than that for ICU TIs (15 [3–91] months; p < 0.001). Proportion of TIs for respiratory decompensation (52% of ED vs. 64% ICU), shock (26% vs. 14%), and neurologic deterioration (30% vs. 11%) also differed by location. Limited neck mobility was reported more often in the ED (16% vs. 6%). TIs in the ED were performed more often via video laryngoscopy (64% vs. 29%). Adverse TIAE rates (15.6% ED, 14% ICU; absolute difference = 1.6%, 95% confidence interval [CI] = –1.1 to 4.2; p = 0.23) and severe TIAE rates (5.4% ED, 5.8% ICU; absolute difference = –0.3%, 95% CI = –2.0 to 1.3; p = 0.68) were not different. Oxygen desaturation was less commonly reported in ED TIs (13.6%) than ICU TIs (17%, absolute difference = –3.4%, 95% CI = –5.9 to –0.8; p = 0.016). Among ED TIs, shock as an indication (adjusted odds ratio [aOR] = 2.15, 95% CI = 1.26 to 3.65) and limited mouth opening (aOR = 1.74, 95% CI = 1.04 to 2.93) were independently associated with TIAEs.

Conclusions

While TI characteristics vary between pediatric EDs and ICUs, outcomes are similar. Shock and limited mouth opening were independently associated with adverse TI events in the ED.