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Post-intubation acute laryngeal injuries in infants and children: A new classification system
Cláudia Schweiger1, Denise Manica1, Gabriel Kuhl2
1Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Insights
The Classification of Acute Laryngeal Injuries (CALI) accurately predicts subglottic stenosis in intubated children. CALI demonstrated superior sensitivity and specificity compared to other laryngeal injury classifications.
Area of Science:
- Pediatric Otolaryngology
- Laryngology
- Critical Care Medicine
Background:
- Subglottic stenosis is a serious complication in intubated children.
- Accurate classification of acute laryngeal injuries is crucial for predicting outcomes.
- Existing classification systems may lack optimal sensitivity and specificity.
Purpose of the Study:
- To compare the Classification of Acute Laryngeal Injuries (CALI) with existing systems.
- To determine the most sensitive and specific classification for predicting subglottic stenosis.
- To evaluate CALI's predictive value for chronic laryngeal injury.
Main Methods:
- Flexible fiber-optic laryngoscopy (FFL) was performed on 194 intubated children within 8 hours of extubation.
- Laryngeal injuries were classified using CALI and adapted systems (Lindholm, Colice, Benjamin).
- Children were monitored for the development of subglottic stenosis.
Main Results:
- CALI demonstrated 90% sensitivity and 73% specificity in predicting subglottic stenosis.
- CALI showed significantly higher specificity than Colice and Benjamin classifications (p < 0.001).
- CALI exhibited significantly greater sensitivity than the Lindholm classification (p < 0.001).
Conclusions:
- CALI effectively identifies children at risk for subglottic stenosis, with 90% of affected children having moderate to severe injuries on initial FFL.
- CALI incorporates injury types and a severity scale, proving predictive of chronic laryngeal injury development.
- CALI offers a robust tool for classifying acute laryngeal injuries and predicting stenosis in pediatric patients.
Objective:
To compare the Classification of Acute Laryngeal Injuries (CALI) with other classifications to determine which of these offers the greatest sensitivity and specificity in predicting the development of subglottic stenosis.
Methods:
All children intubated for the first time in the pediatric intensive care unit were included and subjected to flexible fiber-optic laryngoscopy (FFL) within 8 h of extubation. Their injuries were categorized using the CALI, as well as adapted classifications from Lindholm, Colice and Benjamin. The children were followed up to determine who developed subglottic stenosis.
Results:
This study included 194 children, with a median age of 2.67 months. The sensitivity and specificity of the CALI were 90% and 73%, respectively. The CALI showed greater specificity than the adapted classifications from Colice and Benjamin (p < 0.001 for both), and greater sensitivity than the adapted classification from Lindholm (p < 0.001).
Conclusions:
Based on the CALI, 90% of children who developed subglottic stenosis had moderate to severe injuries on the initial FFL. The CALI includes all injury types described by Benjamin, as well as a proposed severity scale for these lesions, and was predictive of the development of chronic laryngeal injury.
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