Creation and validation of a competency and error metrics for the orotracheal intubation technique using an angled...

The main objective of this study was to create and validate a metric for the correct performance of orotracheal intubation with an angled blade video laryngoscope (GlideScope®). The secondary objectives were to break down the technique into correct phases and steps (competency metrics), define errors and critical errors.

Prospective observational study divided into two phases. In phase I, the metric was created: a group of experts deconstructed the procedure, identifying phases and defining the competence metrics and errors with the help of three previous recordings. The metrics were stress-tested for objectivity and consensus was sought in a meeting of 24 experts using the modified Delphi methodology. In phase II, the metric was validated by recording 9 experienced and 9 novice professionals performing the procedure on a mannequin. Subsequently, 2 external evaluators, previously trained in the use of the metric, evaluated the videos independently.

A metric was created, defined by 4 phases, 22 competency metrics, and 31 errors, of which 16 were considered critical. Experienced professionals completed more competency metrics than novices (17.05 vs. 13.72 (p = 0.010), had fewer total errors (p = 0.0017) and fewer critical errors 0.55 vs. 2.61 (p < 0.001). Inter-rater agreement for the total score of all videos was >0.80.

The metric created is valid and reliably discriminates between operators who are competent and those who are not competent in performing the technique.