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

Christine A Capone¹, Beth Emerson², Todd Sweberg¹, Lee Polikoff³, David A Turner⁴, Michelle Adu-Darko⁵, Simon Li⁶, Lily B Glater-Welt¹, Joy Howell⁷, Calvin A Brown 3rd⁸, Aaron Donoghue^{9

10}, Conrad Krawiec¹¹, Justine Shults¹², Ryan Breuer¹³, Kelly Swain¹⁴, Asha Shenoi¹⁵, Ashwin S Krishna¹⁵, Awni Al-Subu¹⁶, Ilana Harwayne-Gidansky¹⁷, Katherine V Biagas¹⁷, Serena P Kelly¹⁸, Gabrielle Nuthall¹⁹, Josep Panisello²⁰, Natalie Napolitano²¹, John S Giuliano Jr²⁰, Guillaume Emeriaud²², Iris Toedt-Pingel²³, Anthony Lee²⁴, Christopher Page-Goertz²⁵, Dai Kimura²⁶, Mioko Kasagi²⁷, Jenn D'Mello²⁸, Simon J Parsons²⁹, Palen Mallory³⁰, Masafumi Gima³¹, G Kris Bysani³², Makoto Motomura³³, Keiko M Tarquinio³⁴, Sholeen Nett³⁵, Takanari Ikeyama³³, Rakshay Shetty³⁶, Ronald C Sanders Jr³⁷, Jan Hau Lee³⁸, Matthew Pinto³⁹, Alberto Orioles⁴⁰, Philipp Jung⁴¹, Mark Shlomovich⁴², Vinay Nadkarni¹⁰, Akira Nishisaki¹⁰; National Emergency Airway Registry for Children (NEAR4KIDS) Investigators, Pediatric Acute Lung Injury, Sepsis Investigators (PALISI)

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, USA.
² Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
³ Division of Critical Care Medicine, Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁴ Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, North Carolina, USA.
⁵ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia, USA.
⁶ Department of Pediatrics, Robert Wood Johnson University, New Brunswick, New Jersey, USA.
⁷ Pediatric Critical Care Medicine, Department of Pediatrics, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
⁸ Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁰ Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹¹ Department of Pediatrics, Pediatric Critical Care, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.
¹² Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹³ Department of Pediatrics, John R. Oishei Children's Hospital, Buffalo, New York, USA.
¹⁴ Pediatric and Cardiac Critical Care, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ Department of Pediatrics and Critical Care Medicine, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, Kentucky, USA.
¹⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, UW Health American Family Children's Hospital, University of Wisconsin-Madison, Madison, Wisconsin, USA.
¹⁷ Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York, USA.
¹⁸ Department of Pediatrics, Oregon Health & Science University Doernbecher Children's Hospital, Portland, Oregon, USA.
¹⁹ Pediatric Critical Care Medicine, Starship Children's Hospital, Auckland, New Zealand.
²⁰ Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
²¹ Respiratory Care Department, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²² Pediatric Critical Care Medicine, CHU Sainte Justine, Université de Montréal, Montreal, Quebec, Canada.
²³ Division of Pediatric Critical Care, University of Vermont Children's Hospital, Burlington, Vermont, USA.
²⁴ Division of Critical Care Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio, USA.
²⁵ Pediatric Critical Care Medicine, Akron Children's Hospital, Akron, Ohio, USA.
²⁶ Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
²⁷ Pediatric Critical Care & Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
²⁸ Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
²⁹ Section of Critical Care Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
³⁰ Department of Pediatrics, Duke University, Durham, North Carolina, USA.
³¹ Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
³² Medical City Children's Hospital, Dallas, Texas, USA.
³³ Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Aichi, Japan.
³⁴ Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Egleston, Georgia, USA.
³⁵ Section of Pediatric Critical Care Medicine, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
³⁶ Department of Pediatrics, Rainbow Children's Hospital, Bangalore, India.
³⁷ Section of Critical Care, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
³⁸ Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.
³⁹ Pediatric Critical Care Medicine, Maria Fareri Children's Hospital, Valhalla, New York, USA.
⁴⁰ Division of Critical Care, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.
⁴¹ Paediatric Department, University Hospital Schleswig-Holstein Campus, Lübeck, Germany.
⁴² Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York, USA.

PMID: 34923705
DOI: 10.1111/acem.14431

Free article

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

Christine A Capone et al. Acad Emerg Med. 2022 Apr.

Free article

. 2022 Apr;29(4):406-414.

doi: 10.1111/acem.14431. Epub 2022 Jan 12.

Authors

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, USA.
² Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
³ Division of Critical Care Medicine, Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁴ Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, North Carolina, USA.
⁵ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia, USA.
⁶ Department of Pediatrics, Robert Wood Johnson University, New Brunswick, New Jersey, USA.
⁷ Pediatric Critical Care Medicine, Department of Pediatrics, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
⁸ Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁰ Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹¹ Department of Pediatrics, Pediatric Critical Care, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.
¹² Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹³ Department of Pediatrics, John R. Oishei Children's Hospital, Buffalo, New York, USA.
¹⁴ Pediatric and Cardiac Critical Care, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ Department of Pediatrics and Critical Care Medicine, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, Kentucky, USA.
¹⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, UW Health American Family Children's Hospital, University of Wisconsin-Madison, Madison, Wisconsin, USA.
¹⁷ Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York, USA.
¹⁸ Department of Pediatrics, Oregon Health & Science University Doernbecher Children's Hospital, Portland, Oregon, USA.
¹⁹ Pediatric Critical Care Medicine, Starship Children's Hospital, Auckland, New Zealand.
²⁰ Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
²¹ Respiratory Care Department, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²² Pediatric Critical Care Medicine, CHU Sainte Justine, Université de Montréal, Montreal, Quebec, Canada.
²³ Division of Pediatric Critical Care, University of Vermont Children's Hospital, Burlington, Vermont, USA.
²⁴ Division of Critical Care Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio, USA.
²⁵ Pediatric Critical Care Medicine, Akron Children's Hospital, Akron, Ohio, USA.
²⁶ Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
²⁷ Pediatric Critical Care & Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
²⁸ Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
²⁹ Section of Critical Care Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
³⁰ Department of Pediatrics, Duke University, Durham, North Carolina, USA.
³¹ Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
³² Medical City Children's Hospital, Dallas, Texas, USA.
³³ Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Aichi, Japan.
³⁴ Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Egleston, Georgia, USA.
³⁵ Section of Pediatric Critical Care Medicine, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
³⁶ Department of Pediatrics, Rainbow Children's Hospital, Bangalore, India.
³⁷ Section of Critical Care, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
³⁸ Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.
³⁹ Pediatric Critical Care Medicine, Maria Fareri Children's Hospital, Valhalla, New York, USA.
⁴⁰ Division of Critical Care, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.
⁴¹ Paediatric Department, University Hospital Schleswig-Holstein Campus, Lübeck, Germany.
⁴² Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York, USA.

PMID: 34923705
DOI: 10.1111/acem.14431

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.

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References

REFERENCES

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

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

Authors

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