48 Paediatric intubation in an adult-based community hospital emergency department (ED)
Bibliographic record
Abstract
Abstract Background Airway intubation is a high-risk procedure, especially in the paediatric population. Training ED healthcare providers is challenging because it is rare. Success and adverse events (AEs) could be due to patients’ illness, the health professional intubating, and hospital factors. Objectives Describe paediatric intubations in an adult community-based hospital, with primary outcomes being first-pass success and AEs. The secondary objective is to determine what factors are association with intubation success and related AEs. Design/Methods Retrospective chart review of patients < 18 years intubated in the ED between Jan 1, 2006 and Mar 31, 2017 (demographics, intubation details, physiologic outcomes). Analysis: descriptive and comparative statistics (intubations with vs. without AEs), p<0.05 significant. Results n=121 intubations occurred in the ED over the 10-year period. Mean (standard deviation) age 6.9 (6.8) years. First pass success occurred in n=76 (62.8%), and 33 (27.3%) second pass success. There was n=22 (18.2) minor AEs, n=3 (2.5) major AEs. There were no significant differences between profession intubating and first pass success (p=0.384), or AEs (p=0.472), Table 1. Indications for intubation included respiratory and/or oxygenation failure n=54 (44.6%), airway protection n=51 (42.2%), airway obstruction n=4 (3.3%), cardiopulmonary arrest n=2 (1.7%) [n=9 missing]. Use of specialized equipment was used in n=19 of the intubations, n=12 on first attempt, 8 second attempt, 4 third attempt. No accidental extubations occurred, but the ETT was repositioned in n=33 (27%) after first intubation. Conclusion Pediatric intubation in an adult community-based hospital is rare. Success rate of intubation on first attempt is low with minor AEs. There was no significant difference between the type of health professional intubating. These results will inform the development of tools and education for paediatric advanced airway management in adult community-based hospitals, and enhance patient outcomes in the ED.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".