A taxonomy of errors for pediatric emergency intubation

Area of Science:

• Pediatric Emergency Medicine
• Airway Management
• Medical Simulation & Training

Background:

• Pediatric intubation presents unique challenges compared to adults.
• A structured system for classifying intubation errors is needed for quality assurance in the Pediatric Emergency Department (PED).
• Existing adult airway literature provides a foundation for video laryngoscopy (VL) error classification.

Purpose of the Study:

• To adapt an existing adult airway error classification system for pediatric intubations.
• To determine the frequency of specific intubation errors in a Pediatric Emergency Department setting.

Main Methods:

• Prospective, observational study of recorded pediatric intubation attempts.
• Development of error definitions through pilot video review.
• Coding of 100 successive de-identified videos for 12 specific errors and attempt duration.

Main Results:

• The most frequent errors included suboptimal view (42%), inadequate lifting (40%), and blade insertion left of midline (26%).
• Successful intubations (74%) had fewer errors (median 1) than unsuccessful ones (median 3).
• Faster successful intubations (<45s) were associated with fewer errors, with inadequate lifting and suboptimal view being significant factors.

Conclusions:

• A modified error classification system for pediatric intubation was developed and its error frequencies determined.
• This system can establish a standardized quality assurance process for pediatric intubation.
• Findings can inform trainee education and individual coaching for improved pediatric airway management.