• Christine A Capone, Beth Emerson, Todd Sweberg, Lee Polikoff, David A Turner, Michelle Adu-Darko, Simon Li, Lily B Glater-Welt, Joy Howell, Calvin A Brown, Aaron Donoghue, Conrad Krawiec, Justine Shults, Ryan Breuer, Kelly Swain, Asha Shenoi, Ashwin S Krishna, Awni Al-Subu, Ilana Harwayne-Gidansky, Katherine V Biagas, Serena P Kelly, Gabrielle Nuthall, Josep Panisello, Natalie Napolitano, John S Giuliano, Guillaume Emeriaud, Iris Toedt-Pingel, Anthony Lee, Christopher Page-Goertz, Dai Kimura, Mioko Kasagi, Jenn D'Mello, Simon J Parsons, Palen Mallory, Masafumi Gima, G Kris Bysani, Makoto Motomura, Keiko M Tarquinio, Sholeen Nett, Takanari Ikeyama, Rakshay Shetty, Ronald C Sanders, Jan Hau Lee, Matthew Pinto, Alberto Orioles, Philipp Jung, Mark Shlomovich, Vinay Nadkarni, Akira Nishisaki, and National Emergency Airway Registry for Children (NEAR4KIDS) Investigators, Pediatric Acute Lung Injury, Sepsis Investigators (PALISI).
• Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, USA.
• Acad Emerg Med. 2022 Apr 1; 29 (4): 406-414.

BackgroundTracheal 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.MethodsConsecutive 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.ResultsA 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.ConclusionsWhile 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.© 2021 by the Society for Academic Emergency Medicine.

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