• Matthew B Kauffman, Jun Liu, Richard D Urman, Kara G Fields, and Dongdong Yao.
• Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. Electronic address: mkauffman1@partners.org.
• J Clin Anesth. 2020 Oct 1; 65: 109807.

Study ObjectiveTo assess whether anesthesia providers' interpretations of a difficult intubation are consistent with current guidelines and explore possible explanations for any observed discrepancy including video laryngoscopy usage.DesignA retrospective data analysis of tracheal intubation records from the electronic health record of a large healthcare system in the United States from January to June 2018.SettingGeneral anesthesia encounters that involved a tracheal intubation in the operating rooms and non-operating room areas, including procedural areas, medical/surgical floors, and intensive care units.PatientsRecords for 30,072 adult patients (33,142 cases) were identified for analysis. Patient age ranged from 18 to 100 and ASA physical status from I to V.InterventionsNone.MeasurementsThe magnitude and direction of disagreement regarding intubation difficulty was estimated by examining anesthesiologist documentation vs. the American Society of Anesthesiologists guideline definitions. Any explanations for disagreement provided by clinicians were also analyzed. Furthermore, the association between video laryngoscopy and odds of disagreement was assessed.Main ResultsWhile documentation of intubation difficulty in over 95% of records was consistent with current definitions, disagreement occurred in 1.6% of cases using the number of attempts definition (N = 31,964) and in 4.6% of cases using the Cormack-Lehane grade definition (N = 25,407). Some of the most frequently identified explanations clinicians gave in these cases of disagreement included the use of video laryngoscopy (used to explain documented difficult and easy intubations), clinician experience level, and the use of airway assist devices. Video laryngoscopy use was associated with greater odds of disagreement between anesthesiologist documentation and guideline definitions.ConclusionsA review of electronic anesthesia records suggests that clinicians inconsistently interpret and document difficult intubations in light of current guideline definitions and that video laryngoscopy usage appears to be associated, albeit not necessarily independently, with a greater discrepancy between anesthesiologist documentation and guideline definitions.Copyright © 2020 Elsevier Inc. All rights reserved.

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