Article Text
Abstract
Objective To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management.
Methods We conducted a retrospective cross-sectional medical record review of all ‘lights and sirens’ emergency medicine services transports from 2008 to 2011 in patients <18 years of age in the Portland Oregon metropolitan area. A chart review tool (see online supplementary appendix) was adapted from landmark patient safety studies and revised after pilot testing. Expert panels of physicians and paramedics performed blinded reviews of each chart, identified safety events and described their nature. The primary outcomes were presence and severity of patient safety events related to airway management including oxygen administration, bag-valve-mask ventilation (BVM), airway adjuncts and endotracheal intubation (ETI).
supplementary appendix
Results From the 11 328 paediatric transports during the study period, there were 497 ‘lights and sirens’ (code 3) transports (4.4%). 7 transports were excluded due to missing data. Of the 490 transports included in the analysis, 329 had a total of 338 airway management procedures (some had more than 1 procedure): 61.6% were treated with oxygen, 15.3% with BVM, 8.6% with ETI and 2% with airway adjuncts. The frequency of errors was: 21% (71/338) related to oxygen use, 9.8% (33/338) related to BVM, 9.5% (32/338) related to intubation and 0.9% (3/338) related to airway adjunct use. 58% of intubations required 3 or more attempts or failed altogether. Cardiac arrest was associated with higher odds of a severe error.
Conclusions Errors in paediatric out-of-hospital airway management are common, especially in the context of intubations and during cardiac arrest.
- ACCIDENT & EMERGENCY MEDICINE
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Footnotes
Contributors MH contributed to the design of the study, analysis of data and writing of the manuscript. GM, WL and J-MG contributed to the design of the study, development of data collection tools, collection, validation, and analysis of data, and critical review of the manuscript. CD and KD contributed to the design of the study, development of data collection tools, collection, validation, and analysis of data and provided a critical review of the manuscript. JVO contributed to the analysis of data and provided a critical review of the manuscript.
Funding This work is supported by the National Heart Lung and Blood Institute (NHLBI) grant number 5K12HL108974-03. This work is also supported by the National Institute of Child Health and Human Development grant: ‘Epidemiology of Preventable Safety Events in Pre-hospital EMS of Children’, Grant # 1R01HD062478-04. All researchers had independence from the funder with regard to the design, conduct and analysis of the study.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institute of Child Health and Human Development, or the National Institutes of Health.
Competing interests None declared.
Ethics approval The Institutional Review Board of Oregon Health and Science University approved all study components (IRB Number 00006942).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.